Do Colorectal Cancer Patients Understand That Their Family Is at Risk?

  • David T. Rubin
  • Rishi K. Gandhi
  • Jeremy T. Hetzel
  • Sydney H. Kinnear
  • Andrew Aronsohn
  • Gordon Wood
  • Nicole Yadron
Original Article

Abstract

Aim

The aim of this study was to assess whether patients with colorectal cancer (CRC) are aware of the risk to family members and to test an educational intervention.

Methods

CRC patients were surveyed regarding their cancer, family history, understanding of familial risk of CRC, and knowledge of existing screening guidelines for their relatives. An educational intervention was mailed to them and 6 months later they were resurveyed.

Results

Of 253 CRC patients who agreed to participate, only 120 (47.4%) knew that their first-degree relatives were at increased risk for CRC. African-American (AA) race, educational background, income, and previous family history of CRC were significant predictive factors on univariate analysis, but only AA race remained significant on multivariate analysis. Two hundred two patients received the educational intervention and were resurveyed. The understanding of family risk did not improve with this intervention.

Conclusion

Most CRC patients do not know about their family members’ risk. Better educational tools are needed.

Keywords

Colorectal cancer Family risk Patient knowledge First-degree relatives 

Notes

Acknowledgments

Funded in part by the Cancer Research Foundation Young Investigator Award, Chicago, IL.

References

  1. 1.
    American Cancer Society. Cancer facts and figures 2006. Atlanta: American Cancer Society; 2006.Google Scholar
  2. 2.
    Seeff LC, King J, Pollack LA, et al. Increased use of colorectal cancer tests—United States, 2002 and 2004. MMWR Morb Mortal Wkly Rep. 2006;55:308–311.Google Scholar
  3. 3.
    Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology. 2003;124:544–560.CrossRefPubMedGoogle Scholar
  4. 4.
    Burt RW, Bishop DT, Lynch HT, et al. Risk and surveillance of individuals with heritable factors for colorectal cancer. WHO collaborating centre for the prevention of colorectal cancer. Bull World Health Organ. 1990;68:655–665.PubMedGoogle Scholar
  5. 5.
    Fuchs CS, Giovannucci EL, Colditz GA, et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med. 1994;331:1669–1674.CrossRefPubMedGoogle Scholar
  6. 6.
    Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American college of gastroenterology guidelines for colorectal cancer screening. Am J Gastroenterol. 2008;104(3):739–750.CrossRefGoogle Scholar
  7. 7.
    U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149(9):627–637.Google Scholar
  8. 8.
    Harris MA, Byles JE. A survey of screening compliance among first degree relatives of people with colon cancer in New South Wales. J Med Screen. 1997;4:29–34.PubMedGoogle Scholar
  9. 9.
    Harris MA, Treloar CJ, Byles JE. Colorectal cancer screening: discussions with first degree relatives. Aust N Z J Public Health. 1998;22:826–828.CrossRefPubMedGoogle Scholar
  10. 10.
    Glanz K, Grove J, Lerman C, et al. Correlates of intentions to obtain genetic counseling and colorectal cancer gene testing among at-risk relatives from three ethnic groups. Cancer Epidemiol Biomarkers Prev. 1999;8:329–336.PubMedGoogle Scholar
  11. 11.
    Petersen GM, Larkin E, Codori AM, et al. Attitudes toward colon cancer gene testing: survey of relatives of colon cancer patients. Cancer Epidemiol Biomarkers Prev. 1999;8:337–344.PubMedGoogle Scholar
  12. 12.
    Shvartzman P, Rivkind E, Neville A, et al. Screening intention and practice among first-degree relatives of colorectal cancer patients in southern Israel. Isr Med Assoc J. 2000;2:675–678.PubMedGoogle Scholar
  13. 13.
    American College of Gastroenterology. Understanding colorectal cancer screening: A consumer education brochure. 2004.Google Scholar
  14. 14.
    Levin TR. Colonoscopy capacity: can we build it? Will they come? Gastroenterology. 2004;127:1841–1844.CrossRefPubMedGoogle Scholar
  15. 15.
    Seeff LC, Manninen DL, Dong FB, et al. Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? Gastroenterology. 2004;127:1661–1669.CrossRefPubMedGoogle Scholar
  16. 16.
    Seeff LC, Richards TB, Shapiro JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology. 2004;127:1670–1677.CrossRefPubMedGoogle Scholar
  17. 17.
    Vijan S, Inadomi J, Hayward RA, et al. Projections of demand and capacity for colonoscopy related to increasing rates of colorectal cancer screening in the United States. Aliment Pharmacol Ther. 2004;20:507–515.CrossRefPubMedGoogle Scholar
  18. 18.
    Ashktorab H, Nouraie M, Hosseinkhah F, Lee E, Rotimi C, Smoot D. A 50-Year review of colorectal cancer in African Americans: implications for prevention and treatment. Dig Dis Sci E-pub ahead of print June 25, 2009.Google Scholar
  19. 19.
    Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133:761–769.PubMedGoogle Scholar
  20. 20.
    Vernon SW. Participation in colorectal cancer screening: a review. J Natl Cancer Inst. 1997;89:1406–1422.CrossRefPubMedGoogle Scholar
  21. 21.
    Yan B, Noone AM, Yee C, Banerjee M, Schwartz K, Simon MS. Racial differences in colorectal cancer survival in the Detroit Metropolitan area. Cancer E-pub ahead of print July 13, 2009.Google Scholar
  22. 22.
    Carethers JM. Racial and ethnic factors in the genetic pathogenesis of colorectal cancer. J Assoc Acad Minor Phys. 1999;10:59–67.PubMedGoogle Scholar
  23. 23.
    Ball JK, Elixhauser A. Treatment differences between blacks and whites with colorectal cancer. Med Care. 1996;34:970–984.CrossRefPubMedGoogle Scholar
  24. 24.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–626.CrossRefPubMedGoogle Scholar
  25. 25.
    Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87:1773–1778.CrossRefPubMedGoogle Scholar
  26. 26.
    Gordon HS, Street RL Jr, Sharf BF, et al. Racial differences in trust and lung cancer patients’ perceptions of physician communication. J Clin Oncol. 2006;24:904–909.CrossRefPubMedGoogle Scholar
  27. 27.
    Halbert CH, Armstrong K, Gandy OH Jr, et al. Racial differences in trust in health care providers. Arch Intern Med. 2006;166:896–901.CrossRefPubMedGoogle Scholar
  28. 28.
    Doescher MP, Saver BG, Franks P, et al. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–1163.CrossRefPubMedGoogle Scholar
  29. 29.
    Petersen LA. Racial differences in trust: reaping what we have sown? Med Care. 2002;40:81–84.CrossRefPubMedGoogle Scholar
  30. 30.
    Dolan NC, Ferreira MR, Fitzgibbon ML, et al. Colorectal cancer screening among African-American and white male veterans. Am J Prev Med. 2005;28:479–482.CrossRefPubMedGoogle Scholar
  31. 31.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–589.CrossRefPubMedGoogle Scholar
  32. 32.
    Groman R, Ginsburg J. Racial and ethnic disparities in health care: a position paper of the American College of Physicians. Ann Intern Med. 2004;141:226–232.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • David T. Rubin
    • 1
    • 2
  • Rishi K. Gandhi
    • 1
  • Jeremy T. Hetzel
    • 1
  • Sydney H. Kinnear
    • 1
  • Andrew Aronsohn
    • 1
  • Gordon Wood
    • 1
  • Nicole Yadron
    • 1
  1. 1.The University of Chicago Medical CenterChicagoUSA
  2. 2.ChicagoUSA

Personalised recommendations