Contribution of family history of gynecologic cancers to associated risk-factors and screening: Analysis of an Internet-based risk assessment tool.

Abstract

e13605 Background: Well-established risk-factors exist for gynecologic cancers (GC): estrogen exposure increases risk of endometrial cancer (EC); HPV infection and smoking are associated with cervical cancer (CC); oral contraceptive (OCP) use may be associated with an increased risk of CC but a reduced risk of EC and ovarian cancer (OC). Women with a family history (FH) of cancer are more likely to receive regular CC screening, but the association between FH of GC and other risk factors has not been investigated. Methods: Reduce My Risk is an Internet tool created in 2009 to provide personalized information regarding cancer risk, available at OncoLink.org. Voluntary participants were asked about risk factors and risk-associated behaviors. Differences between female respondents with v. without FH of GC were analyzed using chi-square test. Results: Among 16,878 female respondents, 841 (5.0%) had FH of CC, 345 (2.0%) EC, 1,117 (6.6%) OC, and 92 (0.5%) vulvar/vaginal (VC) cancer. Those with FH of any GC showed no difference in alcohol consumption compared to those without FH. Those with FH of CC, EC, OC, and VC were more likely to be obese (34.1% v. 24.7%; 37.2% v. 24.9%; 31.4% v. 24.7%, 43.7% v. 25%, p < 0.001 for all). Those with FH of CC were more likely to have first sexual intercourse before age 18 (69.2% v. 57.8%, p < 0.001) and to have > 10 sexual partners (24.0% v. 16.7%, p < 0.001). This group was also more likely to be current smokers (19.3% v. 11.7%, p < 0.001), and to smoke > 1 pack/day (6.5% v. 2.8%, p < 0.001). They were more likely to receive regular CC screening (91.2% v. 86.8%, p = 0.09), though the difference was not statistically significant. Women < 35 y with a FH of CC showed no differences in HPV vaccination rate (37.0% v. 39.3%, p = 0.29). Those with FH of EC were more likely to have menarche before age 12 (39.3% v. 32.0%, p = 0.005), and to have taken post-menopausal HRT for ≥2 y (77.6% vs. 66.8%, p < 0.001). Those with FH of EC, and OC were more likely to have taken OCPs (77.6% v. 66.8%; 71.9% v. 66.7%, p < 0.001 for both). Conclusions: Many with a FH of GC have increased likelihood of both modifiable and non-modifiable risk factors that are associated with the development of cancer. FH of CC did not increase likelihood of regular screening or HPV vaccination, but was associated with smoking, early intercourse, and multiple sexual partners. Future work should explore targeted intervention for those with FH of GC as a teachable opportunity for the benefits of weight reduction, smoking cessation, pap screening, and HPV vaccination.