Skip to main content

Advertisement

Log in

Health and lifestyle behaviors among persons at risk of Lynch syndrome

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate health behaviors among patients with colorectal cancer (CRC) and their at-risk relatives prior to undergoing genetic counseling and testing for Lynch syndrome and to examine associations between health risk behaviors and specific demographic and psychological variables.

Methods

Participants included patients with CRC (n = 319) and their cancer-unaffected relatives (n = 110) who were enrolled in studies regarding Lynch syndrome genetic testing. Prior to undergoing genetic counseling or testing, participants completed a questionnaire including measures of demographic characteristics, health behaviors, cancer screening practices (Pap test, clinical breast exam, and mammogram), and psychological distress.

Results

Unaffected participants scored higher on a risk behavior index (RBI) than patients with CRC (1.7 (SD = 1.0) vs. 1.4 (SD = .09); p < .01). All female participants underwent cancer screening at rates similar to national data. Higher RBI scores were associated with being male, having less education, and age less than 50-years.

Conclusions

We identified several health behaviors for potential intervention, including smoking, alcohol use, and diet. Genetic counseling offers a promising avenue for education and risk behavior reduction in persons at increased risk for cancer due to a familial or genetic predisposition, and a teachable moment to introduce lifestyle modifications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nicolaides NC, Papadopoulos N, Liu B et al (1994) Mutations of two PMS homologues in hereditary nonpolyposis colon cancer. Nature 371:75–80

    Article  CAS  PubMed  Google Scholar 

  2. Papadopoulos N, Nicolaides NC, Liu B et al (1995) Mutations of GTBP in genetically unstable cells. Science 268:1915–1917

    Article  CAS  PubMed  Google Scholar 

  3. Fishel R, Lescoe MK, Copeland NG et al (1993) The human mutator gene homolog MSH2 and its association with hereditary nonpolyposis colon cancer. Cell 75:1027–1038

    Article  CAS  PubMed  Google Scholar 

  4. Bronner CE, Baker SM, Morrison PT et al (1994) Mutation in the DNA mismatch repair gene homologue hMLH1 is associated with hereditary non-polyposis colon cancer. Nature 368:258–261

    Article  CAS  PubMed  Google Scholar 

  5. Palombo F, Gallinari P, Iaccarino I et al (1995) GTBP, a 160-kilodalton protein essential for mismatch-binding activity in human cells. Science 268:1912–1914

    Article  CAS  PubMed  Google Scholar 

  6. Lindor NM, Peterson GM, Hadley DW et al (2006) Recommendations for the care of individuals with an inherited predisposition to Lynch Syndrome: a systematic review. J Am Med Assoc 296:1507–1517

    Article  CAS  Google Scholar 

  7. Lynch H, Lynch JF, Lynch PM, Attard T (2008) Hereditary colorectal cancer syndromes: molecular genetics, genetic counseling, diagnosis, and management. Fam Cancer 7:27–39

    Article  CAS  PubMed  Google Scholar 

  8. Schmeler KM, Lynch HT, Chen L et al (2006) Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch Syndrome. N Engl J Med 354:261–269

    Article  CAS  PubMed  Google Scholar 

  9. Giovannucci E (2001) An updated review of the epidemiological evidence that cigarette smoking increases risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 10:725–731

    CAS  PubMed  Google Scholar 

  10. Colangelo LA, Gapstur SM, Gann PJ, Dyer AR (2004) Cigarette smoking and colorectal carcinoma mortality in a cohort with long-term follow-up. Cancer 100:288–293

    Article  PubMed  Google Scholar 

  11. Luchtenborg M, Weijenberg MP, Kampman E et al (2005) Cigarette smoking and colorectal cancer: APC mutations, hMLH1 expression, and GSTM1 and GSTT1 polymorphisms. Am J Epidemiol 161:806–815

    Article  PubMed  Google Scholar 

  12. Cho E, Smith-Warner SA, Ritz J et al (2004) Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. Ann Intern Med 140:603–613

    PubMed  Google Scholar 

  13. Mizoue T, Inoue M, Tanaka K et al (2006) Tobacco smoking and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol 36:25–39

    Article  PubMed  Google Scholar 

  14. Peppone LJ, Mahoney MC, Cummings KM et al (2008) Colorectal cancer occurs earlier in those exposed to tobacco smoke: implications for screening. J Cancer Res Clin Oncol 134:743–751

    Article  PubMed  Google Scholar 

  15. Slattery ML, Edwards S, Curtin K, SchaVer D, Neuhausen S (2003) Associations between smoking, passive smoking, GSTM-1, NAT2, and rectal cancer. Cancer Epidemiol Biomarkers Prev 12:882–889

    CAS  PubMed  Google Scholar 

  16. World Cancer Research Fund American Institute for Cancer Research (1997) Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. American Institute for Cancer Research

  17. Beresford SA, Johnson KC, Ritenbaugh C et al (2006) Low-fat dietary pattern and risk of colorectal cancer: the women’s health initiative randomized controlled dietary modification trial. Obstet Gynecol Surv 61:456–458

    Article  Google Scholar 

  18. International Agency for Research on Cancer (2003) Fruits and Vegetables. International Agency for Research on Cancer, World Health Organization

  19. Kimura Y, Kono S, Toyomura K et al (2007) Meat, fish, and fat intake in relation to subsite-specific risk of colorectal cancer: the Fukuoka colorectal cancer study. Cancer Sci 98:590–597

    Article  CAS  PubMed  Google Scholar 

  20. Lin J, Zhang SM, Cook NR et al (2005) Dietary intakes of fruit, vegetables, and fiber, and risk for colorectal cancer in a prospective cohort of women (United States). Cancer Causes Control 16:225–233

    Article  PubMed  Google Scholar 

  21. Potter JD (1996) Nutrition and colorectal cancer. Cancer Causes Control 7:127–146

    Article  CAS  PubMed  Google Scholar 

  22. Park Y, Hunter DJ, Speigelman D et al (2005) Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. J Am Med Assoc 294:2849–2857

    Article  CAS  Google Scholar 

  23. Schatzkin A, Mouw T, Park Y (2007) Dietary fiber and whole-grain consumption in relation to colorectal cancer in the NIH-AARP diet and health study. Am J Clin Nutr 85:1353–1360

    CAS  PubMed  Google Scholar 

  24. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348:1625–1638

    Article  PubMed  Google Scholar 

  25. Vainio H, Bianchini F (2002) Weight control and physical activity. International Agency for Cancer Research Press

  26. Martinez ME, Giovannucci E, Spiegelman D et al (1997) Leisure-time physical activity, body size, and colon cancer in women: Nurses’ Health Study Research Group. J Natl Cancer Inst 89:948–955

    Article  CAS  PubMed  Google Scholar 

  27. Samad AKA, Taylor RS, Marshall T, Chapman MAS (2004) A meta-analysis of the association of physical activity with reduced risk of colorectal cancer. Colorectal Dis 7:204–213

    Article  Google Scholar 

  28. Slattery ML, Edwards S, Ma K, Friedman GD, Potter JD (1997) Physical activity and colon cancer: a public health perspective. Ann Epidemiol 7:137–145

    Article  CAS  PubMed  Google Scholar 

  29. Meyerhardt JA, Heseltine D, Niedzwiecki D et al (2006) Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 24:3535–3541

    Article  PubMed  Google Scholar 

  30. Courneya KS, Friedenreich CM, Quinney HA et al (2004) Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors. Psychooncology 13:857–866

    Article  PubMed  Google Scholar 

  31. Lynch BM, Cerin E, Owen N, Aitken JF (2007) Associations of leisure-time physical activity with quality of life in a large, population-based sample of colorectal cancer survivors. Cancer Causes Control 18:735–742

    Article  PubMed  Google Scholar 

  32. Diergaarde B, Braam H, Vasen H et al (2007) Environmental factors and colorectal tumor risk in individuals with hereditary nonpolyposis colorectal cancer. Clin Gastroenterol Hepatol 5:736–742

    Article  PubMed  Google Scholar 

  33. Watson P, Ashwathnarayan R, Lynch HT, Roy HK (2004) Tobacco use and increased colorectal cancer risk in patients with hereditary nonpolyposis colorectal cancer (Lynch syndrome). Arch Intern Med 164:2429–2431

    Article  PubMed  Google Scholar 

  34. Pande M, Lynch P, Hopper J, et al. (2009) Smoking and colorectal cancer in Lynch syndrome: results from the Colon Cancer Family Registry and The University of Texas M. D. Anderson Cancer Center. Clin Cancer Res (in press)

  35. Meiser B (2005) Psychological impact of genetic testing for cancer susceptibility: an update of the literature. Psychooncology 14:1060–1074

    Article  PubMed  Google Scholar 

  36. Hadley DW, Jenkins JF, Dimond E et al (2004) Colon cancer screening practices after genetic counseling and testing for hereditary nonpolyposis colorectal cancer. J Clin Oncol 22:39–44

    Article  PubMed  Google Scholar 

  37. Hughes Halbert C, Lynch H, Lynch J et al (2004) Colon cancer screening practices following genetic testing for hereditary nonpolyposis colon cancer (HNPCC) mutations. Arch Intern Med 164:1881–1887

    Article  Google Scholar 

  38. Ramsey S, Blough D, McDermott C, et al. (2009) Will knowledge of gene-based colorectal cancer disease risk influence quality of life and screening behavior? Public Health Genomics

  39. Brodersen N, Sutton S, Goff S, Hodgson S, Thomas H (2004) Anticipated reactions to genetic testing for hereditary non-polyposis colorectal cancer susceptibility. Clin Genet 66:437–444

    Article  CAS  PubMed  Google Scholar 

  40. Emmons K, Kalkbrenner K, Klar N et al (2000) Behavior risk factors among women presenting for genetic testing. Cancer Epidemiol Biomarkers Prev 9:89–94

    CAS  PubMed  Google Scholar 

  41. Madlensky L, Flatt SW, Bardwell WA, Rock CL, Pierce JP (2005) Is family history related to preventive health behaviors and medical management in breast cancer patients? Breast Cancer Res Treat 90:47–54

    Article  PubMed  Google Scholar 

  42. Madlensky L, Vierkant RA, Vachon CM et al (2005) Preventive health behaviors and familial breast cancer. Cancer Epidemiol Biomarkers Prev 14:2340–2345

    Article  PubMed  Google Scholar 

  43. Lemon SC, Zapka JG, Clemow L (2004) Health behavior change among women with recent familial diagnosis of breast cancer. Prev Med 39:253–262

    Article  PubMed  Google Scholar 

  44. Audrain J, Schwartz M, Herrera J, Goldman P, Bush A (2001) Physical activity in first-degree relatives of breast cancer patients. J Behav Med 24:587–603

    Article  CAS  PubMed  Google Scholar 

  45. Biesecker BB, Marteau TM (1999) The future of genetic counseling: an international perspective. Nat Genet 22:133–137

    Article  CAS  Google Scholar 

  46. Lipton LR, Johnson V, Cummings C et al (2004) Refining the Amsterdam criteria and Bethesda guidelines: testing algorithms for the prediction of mismatch repair mutation status in the familial cancer clinic. J Clin Oncol 22:4934–4943

    Article  CAS  PubMed  Google Scholar 

  47. Vernon SW, Gritz ER, Peterson SK et al (1997) Correlates of psychologic distress in colorectal cancer patients undergoing genetic testing for hereditary colon cancer. Health Psychol 16:73–86

    Article  PubMed  Google Scholar 

  48. Vernon SW, Gritz ER, Peterson SK et al (1999) Intention to learn results of genetic testing for hereditary colon cancer. Cancer Epidemiol Biomarkers Prev 8:353–360

    CAS  PubMed  Google Scholar 

  49. Gritz ER, Peterson SK, Vernon SW et al (2005) Psychological impact of genetic testing for hereditary nonpolyposis colorectal cancer. J Clin Oncol 23:1902–1910

    Article  PubMed  Google Scholar 

  50. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  51. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) State-trait anxiety inventory for adults. Mind Garden, Palo Alto

    Google Scholar 

  52. Sarason IG, Levine HM, Basham RB, Sarason BR (1983) Assessing social support: the social support questionnaire. J Pers Soc Psychol 1:127–139

    Google Scholar 

  53. Ferrans C, Powers M (1992) Psychometric assessment of the quality of life index. Res Nurs Health 15:29–38

    Article  CAS  PubMed  Google Scholar 

  54. Center for Disease Control (2009) Behavioral risk factor surveillance system. http://www.cdc.gov/BRFSS/. 18 May 2009

  55. Abrams D, Boutwell W, Grizzle J et al (1994) Cancer control at the workplace: the working well trial. Prev Med 23:15–27

    Article  CAS  PubMed  Google Scholar 

  56. Snijders TAB, Bosker RJ (1999) Multilevel analysis: an introduction to basic and advanced multilevel modeling. Sage, London

    Google Scholar 

  57. Emmons KM, McBride CM, Puleo E et al (2005) Prevalence and predictors of multiple behavioral risk factors for colon cancer. Prev Med 40:527–534

    Article  PubMed  Google Scholar 

  58. Meyerhardt JA, Heseltine D, Niedzwiecki D et al (2006) Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 24:3535–3541

    Article  PubMed  Google Scholar 

  59. Demark-Wahnefried W, Aziz N, Rowland J, Pinto B (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23:5814–5830

    Article  PubMed  Google Scholar 

  60. Satia J, Campbell M, Galanko J et al (2004) Longitudinal changes in lifestyle behaviors and health status in colon cancer survivors. Cancer Epidemiol Biomarkers Prev 13:1022–1031

    PubMed  Google Scholar 

  61. Rees G, Gaff C, Young M, Martin P (2007) Health beliefs and behaviors of women who have received genetic counseling for breast cancer. J Genet Couns 16:457–468

    Article  PubMed  Google Scholar 

  62. Spector D (2007) Lifestyle behaviors in women with a BRCA1 or BRCA2 genetic mutation: an exploratory study guided by concepts derived from the health belief model. Cancer Nurs 29:E1–E10

    Article  Google Scholar 

  63. McBride C, Brody L (2007) Point: genetic risk feedback for common disease-time to test the waters. Cancer Epidemiol Biomarkers Prev 16:1724–1726

    Article  PubMed  Google Scholar 

  64. McBride C, Alford S, Reid R et al (2008) Putting science over supposition in the arena of personalized genomics. Nat Genet 40:939–942

    Article  CAS  PubMed  Google Scholar 

  65. Lawson P, Flocke S (2009) Teachable moments for health behavior change: a concept analysis. Patient Educ Couns 76:25–30

    Article  PubMed  Google Scholar 

  66. Quach J, Porter K, Leventhal H (2009) Health behaviors among Ashkenazi Jewish individuals receiving counseling for BRCA1 and BRCA2 mutations. Fam Cancer

  67. Schneider K (2002) Counseling about cancer—strategies for genetic counseling. Wiley-Liss, Inc, New York

    Google Scholar 

  68. Rees G, Young M, Gaff C, Martin P (2006) A qualitative study of health professionals’ views regarding provision of information about health-protective behaviors during genetic consultation for breast cancer. J Genet Couns 15:95–104

    Article  PubMed  Google Scholar 

  69. Emmons K, McBride C, Puleo E et al (2005) Project PREVENT: a randomized trial to reduce multiple behavioral risk factors for colon cancer. Cancer Epidemiol Biomarkers Prev 14:1453–1459

    Article  PubMed  Google Scholar 

  70. American Cancer Society (2005) Colorectal cancer facts and figures special edition 2005. American Cancer Society

  71. United States Preventive Services Task Force (2008) The guide to clinical preventive services. Agency for Healthcare Research and Quality

  72. Cook A, Friday J, Subar A (2004) Dietary source nutrient database for USDA survey food codes. http://www.ars.usda.gov/ba/bhnrc/fsrg/. 18 May 2009

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Allison M. Burton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burton, A.M., Peterson, S.K., Marani, S.K. et al. Health and lifestyle behaviors among persons at risk of Lynch syndrome. Cancer Causes Control 21, 513–521 (2010). https://doi.org/10.1007/s10552-009-9482-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-009-9482-0

Keywords

Navigation