Relatives Of Cancer Patients Research Articles

First-degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer

Background & Aims: The risk of colorectal cancer in relatives of patients with adenomatous colonic polyps is not well defined. This study assessed whether finding colonic neoplasia during screening colonoscopy was related to the family history of colorectal cancer among the participants' parents and siblings. Methods: Self-reported family history of colorectal cancer was recorded for all participants in a screening colonoscopy study. The size and location of all polyps were recorded before their removal and histologic examination. Participants were grouped according to the most advanced lesion detected. Results: Three thousand one hundred twenty-one patients underwent complete colonoscopic examination. Subjects with adenomas were more likely to have a family history of colorectal cancer than were subjects without polyps (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.09-1.70). The finding of a small (<1 cm) tubular adenoma as the most advanced lesion was associated with only a modest increase in the OR of colorectal cancer in family members (OR, 1.26; 95% CI, 0.99-1.61), but the presence of an advanced adenoma was associated with a higher OR (OR, 1.62;5% CI, 1.16-2.26). Younger age of adenoma diagnosis was not related to a higher prevalence of a family history of colorectal cancer. Conclusions: Relatives patients with advanced colorectal adenomas have an increased risk of colorectal cancer. Individuals with advanced colorectal adenomas should be counseled about the increased risk of colorectal cancer among their relatives.

Hematopoietic and lymphatic cancers in relatives of patients with infectious mononucleosis.

Young adults with a history of Epstein-Barr virus (EBV)-related infectious mononucleosis have an increased risk for Hodgkin's lymphoma. EBV is detected in Hodgkin's lymphoma Reed-Sternberg cells from some patients, but in young adult patients, it is detected at a relatively low frequency in these cells. Hodgkin's lymphoma and infectious mononucleosis are both associated with high social class, and unknown confounding factors that are also associated with socioeconomic status might explain or contribute to the apparent association between these diseases. To indirectly assess the importance of socioeconomic status on the association between these diseases, we determined the risk for hematopoietic and lymphatic cancers in first-degree relatives of patients with confirmed EBV-related infectious mononucleosis. We identified parents, siblings, and offspring of 17,045 persons with serologically confirmed EBV-related infectious mononucleosis. Subjects in these cohorts were linked with the population-based Danish Cancer Register to identify those developing hematopoietic/lymphatic cancers after the index patient was diagnosed with infectious mononucleosis. The relative risk for cancer in the infectious mononucleosis family members was expressed as standardized incidence ratios (SIRs; i.e., the ratio between the number of cancers observed and the number of cancers expected, obtained from age-specific, sex-specific, and period-specific incidence rates). We identified 8052 parents, 5264 siblings, and 28,605 offspring of patients with EBV-related infectious mononucleosis who were followed for a total of 892,213 person-years at risk. The risk for Hodgkin's lymphoma was unaltered in the combined group of first-degree relatives of these patients (SIR = 0.99; 95% confidence interval [95% CI] = 0.62 to 1.59; number of cases [n] = 17), in the group of parents (SIR = 0.83; 95% CI = 0.31 to 2.22; n = 4), in the group of siblings (SIR = 0.96; 95% CI = 0.31 to 2.97; n = 3), and in the group of offspring (SIR = 1.08; 95% CI = 0.58 to 2.02; n = 10). The unremarkable risk for Hodgkin's lymphoma in family members of patients with EBV-related infectious mononucleosis indicates that socioeconomic confounding is an unlikely explanation for the association between EBV-related infectious mononucleosis and Hodgkin's lymphoma.

Cancer incidence in relatives of patients with testicular cancer in the eastern part of The Netherlands

Objectives. To investigate the incidence of malignant tumors in first-degree relatives of patients with testicular cancer. Methods. Information about the occurrence of cancer in relatives of patients treated for testicular germ cell cancer (TC) at the Department of Urology of the University Medical Centre Nijmegen from 1986 to 1997 was collected using postal questionnaires from 379 (72%) of 524 patients. The expected numbers of cancers in relatives were computed from age- and sex-specific incidence data in the Netherlands Cancer Registry. The observed/expected (O/E) ratios with 95% confidence intervals (CIs) were calculated using Byar’s approximation of the exact Poisson test. Results. The O/E ratio for developing cancer in the families of patients with TC was 1.2 (95% CI 1.0 to 1.3). Among first-degree relatives of patients with TC, more TC was observed than expected (O/E 3.3; 95% CI 1.4 to 6.9). The risk for brothers of patients with TC increased 5.9-fold (95% CI 2.2 to 12.8). Both the risk of developing lung cancer (O/E 1.5) and malignancy of the female genital tract in sisters (O/E 2.8) was slightly increased. In contrast, the risk of urinary tract malignancies (O/E 0.3) and other and unknown primary tumors (O/E 0.2) had a lower incidence among relatives. However, both the increased and decreased risk of nontesticular cancer for first-degree relatives may have been caused by misclassification. Conclusions. TC clusters in families were more pronounced among brothers than among fathers and sons. This study supports previous reports that families of patients with TC do not seem to be prone to nontesticular cancer. Additional investigations in families with TC are recommended to map candidate genes for TC.

Prevalence of colorectal adenomas in individuals with a family history of colorectal cancer based on initial colonoscopy: Implications for colonoscopic surveillance

Background: Increasing evidence suggests that inherited susceptihility is an important factor in the pathogenesis of colorectal adenomas and colorectal cancer; because of that, screening strategies that consider familial risk could increase their effectiveness. Aims : The aim of this study was to know the risk for colorectal adenomas, colorectal cancer and extracolonic cancers in first degree relatives of patients with colorectal adenomas. Methods and Patients : We evaluated patients referred to our institution for initial colonoscopy between June 1996 and July 1997 who did not have a family or personal history of familial polyposis, inflammatory bowel disease neither previous polypectomies or colorectal cancer (n= 379). Patients were divided in two groups: Group A) patients with complete colonoscopy with removal of one or more adenomas (n= 164) and. Group B) patients with complete colonoscopy without adenomas (n= 215). Mean age in group A and B was 62 and 61 respectively (p= NS).As well, no significant differences in sex between group A (MIF 40%/60%) and group B (MIF 52%/48%). They all were interviewed in order to determine if history of colorectal adenomas, colorectal cancer or extracolonic cancers had been documented in their first degree relatives . Result s:A mong first degree relatives of patients with adenomas (n= 1132). 12 ( J.I %) had personal history of colorectal adenomas. 19 (1.7%) of colorect al cancer and 16 ( 1.4%) antecedents of extracolonic cancer. In the group of first degree relatives of those without adenomas (n= 1478). 3 ( 0.2%) had personal history of colorectal adenomas, 16 ( J.I %) of colorec tal cancer and 17 ( 1.1 %) antecedents of extracolon ic cancer. Odds Ratio for colorectal adenomas, colorectal cancer and extracolonic cancers in the relatives of the patients with adenomas as compared with controls was 5 27 ( 95% CI: 1.38-23.53; p=0.009*), 1.72 (95 % CI: 0.79-3.76; p=0.19) and 1.23 (95% CI: 0.59-2.57; p= 0.67) respectively. Conclusions:First degree relatives of patients with newly diagnosed adenomas are at increased risk for developing colorectal adenomas. It supports a familial predisposition for these premalignant lesions and suggests that total colonoscopy screening could be indicated in these subjects.

Risk of colorectal cancer in relatives of patients with inflammatory bowel disease (Denmark)

It has been suggested that inflammatory bowel disease (IBD) and colon cancer are associated because they have genetic susceptibility in common, rather than IBD causing cancer. We examined the risk of colorectal cancer in first-degree relatives of patients with IBD in order to evaluate if they share the same genetic susceptibility. We identified patients with IBD in the Danish Hospital Discharge Registry. A cohort of all first-degree relatives to these patients were linked to the Danish Cancer Registry. Colorectal cancers observed were compared with expected values based on age, gender, and calendar-specific incidence rates in the general population. Among 4,496 patients with IBD, a total of 19,645 relatives were identified. For parents of patients with Crohn's disease, we observed 19 cases of colorectal cancer compared with 20 expected (standardized incidence ratio [SIR] = 1.0, 95 percent confidence interval [CI] = 0.6-1.5). For parents of patients with ulcerative colitis, 55 cases were observed compared with 51 expected (SIR = 1.1, CI = 0.8-1.4). The study did not corroborate the hypothesis that the same genetic factors play a significant role in the etiology of colorectal cancer and IBD, but more information is needed to disregard the possible link between IBD and colon cancer.

Genetic epidemiology of colorectal cancer.

Genetic epidemiological methods have played an integral role in the characterisation of the genetic susceptibilities to colorectal cancer. Classic epidemiological approaches, such as case-control and prospective cohort studies, that utilise family history information have laid the foundation for the more specialised family-based genetic methods, segregation analysis and linkage analysis. The genetic epidemiology of colorectal cancer can be characterised by several themes: the consistently increased risk of colorectal cancer in first-degree relatives of patients with colorectal cancer; genetic predisposition to some, if not the majority of colorectal neoplasms; and genetic heterogeneity of the inherited colorectal cancer syndromes. With the rapid development of molecular genetic techniques, new opportunities for further research include studies to estimate the proportion of colorectal cancer that is accounted for by genetic susceptibility, the number of loci that may be involved, and most importantly, gene-environment interaction studies, not only of the inherited syndromes, but of common colorectal cancer.

Cancer and Imputed Infection: Images of ‘The Disease’ among Patients' Relatives

A description of the social construction of cancer is offered from the cancer patient's relatives' point of view, focusing on the linkage made between contamination and cancer. The ethnography brings together four detailed observations of cancer patients found in a transient stage of remission, who are perceived by their relatives as paradoxically being at one and the same time very good-looking and also very sick. A semiotic explanation to the phenomenon of imputed infection with regard to cancer patients of ‘doubtful appearance’ is discussed, arguing that such imputation can be seen as one of several mechanisms intended to force the disease ‘into the open’ and thus re-align the lost congruence between internal and external.

Increased Risk of Neuroectodermal Tumors and Stomach Cancer in Relatives of Patients With Ewing's Sarcoma Family of Tumors

Previous studies of the genetic epidemiology of Ewing's sarcoma have shown neither an increased incidence nor a distinct pattern of cancers in family members of Ewing's sarcoma patients. Because of a new biologic and cytogenetic classification of Ewing's sarcoma family of tumors, we wanted to reinvestigate the incidence and distribution of cancers in relatives of probands with Ewing's sarcoma family of tumors. Patients treated at the Pediatric Branch and the Radiation Oncology Branch of the National Cancer Institute between 1965 and December 1992, or their next of kin, were asked to complete a questionnaire on the history of cancer in all first- and second-degree relatives. The incidence of cancer in family members was compared with Connecticut Tumor Registry rates specific for sex, age, and 5-year calendar-year intervals. Observed/expected (O/E) ratios, 95% confidence intervals (CIs), and tests of homogeneity were calculated. Four thousand six hundred seventy-eight family members with 196,640 person-years at risk entered the analysis. Overall, there was no increased risk of cancer (observed 472; O/E = 0.9; 95% CI = 0.8-1.0). However, several tumor types were found in significant excess. These tumors included stomach cancer (observed 34; O/E = 2.0; 95% CI = 1.4-2.8), melanoma (observed 23; O/E = 1.9; 95% CI = 1.2-2.8), brain tumor (observed 18; O/E = 1.9; 95% CI = 1.1-3.0), and bone cancer (observed 7; O/E = 4.2; 95% CI = 1.7-8.6). Risks of these cancers were higher among maternal than paternal relatives, but these differences were not statistically significant. There was a significant deficit of bladder cancer (observed 5; O/E = 0.2; 95% CI = 0.1-0.5) and rectal cancer (observed 0; O/E = 0.0; 95% CI = 0.0-0.1). Second-degree relatives had a significant cancer deficit (observed 389; O/E = 0.9; 95% CI = 0.8-0.95). This deficit was accounted for by the observed deficit of bladder and rectal cancer and is probably related to under-reporting or misclassification of cancer in second-degree relatives. Family members of 10 probands with second malignancies did not have an increased risk of all cancers (observed 20; O/E = 1.2; 95% CI = 0.7-1.8) but had an increased risk of both melanoma (observed 3; O/E = 7.3; 95% CI = 1.5-21.0) and breast cancer (observed 8; O/E = 3.2; 95% CI = 1.4-6.3). Finding an increased risk of neuroectodermal tumors and stomach cancer in families of patients with Ewing's sarcoma family of tumors suggests that these tumors might share a common etiology. Further studies should try to confirm this hypothesis and to examine if genetic factors may have a role in these families by assessing the mode of inheritance and examining families with multiple affected members.

The risk of cancer in relatives of patients with brain neoplasm.

The family trees of 142 patients, suffering from histologically proven brain tumour, were compared to those of an equal number of sex and age matched controls. The results showed no statistically significant differences in the occurrence of malignant neoplasm between the two groups. These results indicate that the risk of cancer among relatives of patients with brain tumours does not exceed that of healthy controls.

Risk of cancer in relatives of patients with cutaneous melanoma.

Cutaneous malignant melanoma (CMM) is a recognized feature of the Lynch type II cancer-family syndrome and the Li-Fraumeni's syndrome. A significant contribution of these syndromes to the total burden of CMM would be reflected in an increased risk of nonmelanoma cancers in first degree relatives. Pedigrees were taken from 85 patients with CMM using a family history questionnaire. The relative risk of death from all cancers and individual cancers in first degree relatives was calculated. Of the 85 questionnaires, those of 79 patients were completed and of adequate quality for analysis. The first degree relatives of CMM patients showed no increased risk of cancer death, the relative risk of cancer death being 1.0. Six patients (7.6%) had first degree relatives with CMM. One patient had a family history compatible with the dominant transmission of a predisposition to cancer. It is important to establish whether an increased cancer risk is present in relatives of patients with malignancies so that screening programs may be offered. This study provides little evidence to support seeing relatives for noncutaneous malignancies in the absence of a dominant family history of predisposition to cancers. The increased frequency of CMM in relatives suggests that relatives of CMM patients should be counseled on protection from the sun and examination of the skin for melanoma.

Non‐ocular cancer in patients with hereditary retinoblastoma and their relatives

In The Netherlands, retinoblastoma patients have been registered in the Utrecht national retinoblastoma registry since 1862. This register is virtually complete from 1945 onwards. We describe a unique epidemiological survey of the occurrence of non-ocular cancer in all patients registered during the period 1945-1970. The occurrence of non-ocular cancer in relatives of patients with hereditary retinoblastoma is also reported. One hundred and forty-one patients with hereditary retinoblastoma were studied for non-ocular second primary cancer. Nineteen patients died of retinoblastoma. The median follow-up of the surviving 122 patients was 25 years. Seventeen of these patients developed a second primary cancer, most frequently soft-tissue sarcoma. The cumulative incidence of non-ocular cancer was 19% at the age of 35, i.e., a 14-fold increase as compared to the general population. Twelve patients with hereditary retinoblastoma died of non-ocular cancer whereas none of 252 patients with non-hereditary retinoblastoma died of non-ocular cancer. Furthermore, among the parents of our hereditary retinoblastoma patients, 24 (born before 1945) had also been affected by retinoblastoma or had affected sibs. In the parents, 4 tumors occurred, of which 2 were rhabdomyosarcomas and 2 were urinary bladder cancers. Both types of non-ocular cancer were also encountered among the 122 patients with hereditary retinoblastoma. In 103 fathers and 103 mothers of patients with hereditary retinoblastoma who did not have retinoblastoma themselves, there was no previous family history of retinoblastoma. The fathers had a relative risk of 8.3 for pancreatic cancer compared to the general population. There was no significant increase in the number of non-ocular tumors in 332 sibs of patients with hereditary retinoblastoma.

Cancer in relatives of patients with aplastic anemia

The risk of cancer was examined among family members of 9 patients with Fanconi's anemia. Seven cancers of diverse types were observed, as compared with the 10.4 expected ( P > 0.05). In addition, the study of relatives of 60 patients with acquired aplastic anemia showed no unusual distribution of cancers by site and age at diagnosis. In particular, no relative in either series had acute leukemia. Methodologic issues complicate the interpretation of several published reports of excess cancers among heterozygotes of Fanconi's anemia, ataxia-telangiectasia, and xeroderma pigmentosum.

Some characteristics of familial breast cancer

A genetic study of breast cancer is in progress on 500 patients with positive family histories of the disease. These patients were generally younger and had a higher frequency of bilaterality than did patients with negative family histories. Among familial patients, those with early diagnoses (20 to 44 years) manifested a significantly higher bilaterality rate than did those with intermediate (45 to 54 years) or late diagnoses (55 to 84 years). Blood type O, benign breast disease, and ovarian cysts and tumors also tended to be more common in patients with early diagnoses, while blood type A, diabetes, obesity, hypertension, and uterine disorders were more common in those with later diagnoses. The risk of breast cancer in relatives of patients with bilateral disease was 3 to 4 times higher than that in relatives of patients with unilateral disease. These results could indicate the possibility of at least two types of genetically different breast cancer, and possibly a sporadic type not associated with a family history of the disorder.