Category: Colorectal Cancer Prevention
George Washington University
Approximately 5-10% of cancers are attributable to hereditary cancer syndromes. The ACG recommends that risk assessment includes a detailed family medical history and genetic testing when appropriate. A multi-generational family history optimizes decisions about cancer surveillance and genetic counselling. However, there may be inconsistent documentation of family medical histories during consultations. This study evaluated multigenerational family medical history documentation and genetic counselling referrals during colorectal cancer (CRC) screening consultations.
A chart review evaluated all patients seen in a university GI clinic for CRC screening during a 3 month period. Patient gender, age, self-reported ethnicity and multigenerational (3+ generations) family medical histories were obtained. Consideration for genetic counseling was assessed by Amsterdam II criteria, Bethesda criteria and Colorectal Cancer Risk Assessment Tool. Analysis using Fisher’s Exact Test was performed with significance set at p< 0.05. The study was IRB approved.
Results: 872 records (500 females, 372 males; mean age 59.6) were reviewed. There were 452 African American, 363 white, 54 Hispanic, 42 Asian, 36 other and 34 undocumented. 144 (16.5%; 102 female, 42 male) had a multi-generational family history. Detailed family history was obtained more often in females (p=0.0005) and in whites (p=0.005). 84 (9.6%; 64 female, 20 male) patients qualified for genetic counseling. Females qualified for genetic counseling more often than males (p=0.0002). 21 of the 84 patients (25%; 17 female, 4 male) who qualified were referred or received genetic counselling. Those < 50 years (56.6%; 13/23; p=0.001) were more likely to be referred or receive counselling than others.
Discussion: Multigenerational family medical histories to assess for colon cancer risk was inconsistently performed. Women and whites more often had detailed family histories obtained. Individuals who qualified for genetic counselling were infrequently referred for genetic testing. Women were more likely to qualify for genetic counselling referral compared to males. Individuals who qualified for genetic counselling were likely to receive counseling or a referral if they were < 50 years old. While this study is limited due single-institution design, it provides important information for subsequent studies and educational interventions. It is critical individuals at increased risk for colon cancer are identified to ensure optimization of care.
Joseph Cioffi indicated no relevant financial relationships.
Danielle Kirelik indicated no relevant financial relationships.
Lauren Pascual indicated no relevant financial relationships.
Marie Borum indicated no relevant financial relationships.