Reported Cancer History Research Articles

Attitudes, Perceptions, and Use of Cancer-based Genetic Testing Among Healthy U.S. Adults and Those With Prostate or Breast/Ovarian Cancer.

Differences in public awareness and uptake of genetic testing among patients with inheritable cancers are not well understood. The purpose of this study is to examine self-reported rates of undergoing cancer-specific genetic testing in patients with breast/ovarian cancer vs prostate cancer from a nationally representative sample of U.S. Secondary objectives include examining sources of genetic testing information and perceptions of genetic testing for both patient populations as well as the general public. Data from the National Cancer Institute's Health Information National Trends Survey 5, Cycle 4 were used to generate nationally representative estimates of adults living in the U.S. Our exposure of interest was patient reported cancer history categorized as having: (1) either breast or ovarian cancer, (2) prostate cancer, or (3) no history of cancer. χ2 testing was used to compare differences among categorical variables. In a nationally representative sample of 231.7 million adults, 3.7 million adults reported a history of breast/ovarian cancer while 1.5 million patients reported a history of prostate cancer; 52.3% of patients with breast/ovarian cancer vs 1.0% with prostate cancer reported undergoing cancer-specific genetic testing (P = .001). Patients with prostate cancer were less aware of cancer-specific genetic testing than either individuals with breast/ovarian cancer or adults without a cancer history (19.7% vs 64.7% vs 35.8%, respectively; P = .003). Health care professionals were the most common source of genetic testing information for patients with breast/ovarian cancer whereas the Internet was the most common source for patients with prostate cancer. Our results suggest a lack of awareness and limited utilization of genetic testing among patients with prostate cancer relative to breast/ovarian cancer. Patients with prostate cancer cite the Internet and social media as sources of information, which may be an avenue for more optimal dissemination of evidence-based information.

Physical performance limitations and participation restrictions among cancer survivors: A population-based study from NHANES data 2015-2018.

12096 Background: Anti-cancer therapies have improved survival outcomes in cancer survivors; however, therapy-related toxicities may impact organ structure and function and interfere with physical performance and participation in life roles. This analysis aimed to estimate the prevalence of physical performance limitations (PL) and participation restrictions (PR) among recent (< 5 years since diagnosis), and long-term (≥ 5 years) cancer survivors. Methods: Data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using multivariable logistic regression, accounting for age, sex, race, and income, and incorporating survey sampling methodology. Odds ratios compared proportions of PL and PR among 663 (weighted population estimate 14,319,219) recent and 341 (weighted population estimate 7,261,088) long-term survivors, and 10,284 (weighted population estimate 215,042,155) persons with no reported cancer history. Two-sided two sample z-tests were used to compare proportions to a previous publication of data from 1999-2002 NHANES data. Results: Physical performance limitations were 1.5-1.7 times (63% vs 29%) and PR 1.5-1.6 times (38% vs 18%) more prevalent in cancer survivors than in those with no cancer history. Long-term cancer diagnosis was associated with increased prevalence of PL and PR, particularly in survivors aged 20-39 years. Proportions increased by 7% for PL and by 10% for PR compared to 1999-2002 values (p-values <0.001). Conclusions: Over 60% of cancer survivors reported PL and nearly 40% reported PR. Despite an interim increase in evidence of the benefits of exercise to manage therapy-related toxicities, these values are a significant increase when compared to 1999-2002 NHANES data. Targeted education for providers and exercise interventions aimed to improve physical function and performance in early cancer survivors should be considered to address the physical sequelae from anti-cancer therapies. [Table: see text]

National assessment of recommendations from healthcare providers for smoking cessation among adults with cancer

Cancer survivors benefit from evidence-based smoking cessation treatment. A crucial first step in this process is a clinician recommending that the patient quit smoking. However, contemporary delivery of advice to quit among patients with cancer is not well known. In a cross-sectional analysis of all adult smokers included in a prospective population-representative study of US adults, we analyzed the frequency that patients reported receiving advice to quit smoking from a healthcare professional according to reported cancer history (no cancer, tobacco-related cancer, non-tobacco related cancer history). Among an estimated 28.3 million smokers, 9.3% reported a history of cancer, 48.8% of which were tobacco-related cancers. In general, advice to quit was reported by more (67.8%) cancer survivors than those adults without any cancer (56.0%). After adjustment for sociodemographic factors, smokers with a non tobacco-related cancer (0.51, 95% CI 0.32–0.83) and those without any cancer history (0.43, 95% CI 0.30–0.63) were both less likely to report being advised to quit smoking than patients with a tobacco-related cancer history.

Substance Use in Uninsured Cancer Survivors: A Multicenter Cross-Sectional Study of Free Clinics.

IntroductionSubstance use disorders occur in about 5% of the cancer population and can decrease treatment adherence, impede pain management, and undermine a cancer survivor’s network of social support. Although current literature demonstrates substance use is associated with socioeconomic disparity, there is limited research on the prevalence of alcohol, tobacco, and illicit drug use among uninsured cancer survivors in the United States. Our multicenter cross-sectional study describes the prevalence of substance use in uninsured cancer survivors in the Tampa Bay Area.MethodsA comprehensive retrospective chart review of electronic medical records and paper charts was conducted at nine free clinics in the Tampa Bay Area of Florida between January 1, 2016, and December 31, 2017. Substance use prevalence was compared between uninsured cancer survivors and uninsured patients without reported cancer history after adjusting for available demographic risk factors.ResultsThere were 222 patients with a history of cancer and 6,768 patients without a history of cancer included for analysis. Cancer survivors had a median age of 55 years (interquartile range 48-61 years), were mostly female (n = 146, 66.1%), and of Hispanic ethnicity (n = 94, 52.5%). Cancer survivors were more likely to be current smokers (n = 42, 25.1%) compared to patients without a cancer history (n = 759, 16.1%). Patients with a history of cancer were more likely to be current drinkers (n = 34, 26%) compared to non-cancer patients (n = 942, 22.9%). There was no significant difference in illicit drug use history between the two groups.ConclusionsOur study demonstrates that uninsured cancer survivors are more likely to be smokers and alcohol consumers than uninsured patients without a history of cancer. There was no significant difference in illicit drug use in cancer survivors and patients without a history of cancer. Future educational interventions should target substance use among uninsured cancer survivors.

Abstract A019: Substance use in uninsured cancer survivors from free clinics

Abstract Introduction: Approximately 8% of Americans suffer from alcoholism and roughly one-third of Americans endorse illicit drug use. Compared to the general population, substance abuse disorders only occur within 5% of the cancer population. Among cancer survivors, the use of alcohol was comparable to non-cancer survivors while the use of tobacco and illicit drugs was lower. Substance use can decrease treatment adherence, impede pain management, and undermine their network of social support. Our study aims to document the prevalence of substance use in uninsured cancer survivors. Methods: A retrospective chart review was conducted to manually collect chronic disease parameters from electronic medical records and paper charts at 9 free clinics in the Tampa Bay Area of Florida. Data was abstracted using a questionnaire on Redcap software. There were 222 patients with a documented history of cancer in the study and 6,768 patients with a documented negative history of cancer. Demographics were compared between cancer survivors and patients without reported cancer history using chi-square test or independent samples t-test using an alpha of 0.05 for all tests. Results: The majority of the cancer patients were female, n=146 (66.1%). Survivors were significantly older than patients without cancer 54.1 (SD=12) vs. 41 (SD=16.7), p<0.001. Cancer survivors were largely of Caucasian race (n=79, 44.1%) and Hispanic ethnicity (n=79, 44.1%). Patients with a reported cancer history were significantly less likely to be African American (n=6, 3.4%) compared to patients without a history of cancer (n=696, 14.1%) p<0.001. There was no significant difference in current or past drug use between two groups. Cancer survivors were more likely to be current smokers (n=43, 25.6%) compared to patients without cancer history (n=763, 16.1%), p<0.001. Cancer survivors were more likely to be past smokers (n=34, 20.2%) compared to patients without cancer history (n=472, 9.9%), p<0.001. Patients with a history of cancer were more likely to be current drinkers (n=34, 26%) compared to patients without a cancer diagnosis in the study (n=942, 22.9%), p=0.003. Cancer survivors were also more likely to report a history of drinking (n=13, 9.9%) than patients without a history of cancer (n=139, 3.4%), p=0.003. Conclusions: Although current literature demonstrates substance use is associated with socioeconomic disparity, there is limited research on the prevalence of alcohol, tobacco, and illicit drug use among uninsured cancer survivors in the United States. Our study finds that uninsured cancer survivors are more likely to be current and past alcohol users but are just as likely to use illicit substances as uninsured patients without a history of cancer. Our study suggests survivors continue to be at risk for tobacco and alcohol use. More research is needed to evaluate substance use among uninsured cancer survivors. Citation Format: Madeline MacDonald, Shreni Shah, Justin Swanson, Ethan Song, Rahul Mhaskar, Smitha Pabbathi, Abu-Sayeef Mirza. Substance use in uninsured cancer survivors from free clinics [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A019.

Prevalence and characteristics of likely-somatic variants in cancer susceptibility genes among individuals who had hereditary pan-cancer panel testing

Next-generation sequencing (NGS) hereditary pan-cancer panel testing can identify somatic variants, which exhibit lower allele frequencies than do germline variants and may confound hereditary cancer predisposition testing. This analysis examined the prevalence and characteristics of likely-somatic variants among 348,543 individuals tested using a clinical NGS hereditary pan-cancer panel. Variants showing allele frequencies between 10% and 30% were interpreted as likely somatic and identified in 753 (0.22%) individuals. They were most frequent in TP53, CHEK2 and ATM, commonly as C-to-T transitions. Among individuals who carried a likely-somatic variant and reported no personal cancer history, 54.2% (78/144) carried a variant in TP53, CHEK2 or ATM. With a reported cancer history, this percentage increased to 81.1% (494/609), predominantly in CHEK2 and TP53. Their presence was associated with age (OR=3.1, 95% CI 2.5, 3.7; p<0.001) and personal history of cancer (OR=3.3, 95% CI 2.7, 4.0; p<0.001), particularly ovarian cancer. Germline ATM pathogenic variant carriers showed significant enrichment of likely-somatic variants (OR=2.8, 95% CI 1.6, 4.9; p = 0.005), regardless of cancer status. The appearance of likely-somatic variants is consistent with clonal hematopoiesis, possibly influenced by cancer treatment. These findings highlight the precision required of diagnostic laboratories to deliver accurate germline testing results.

Germline mutation prevalence in individuals with pancreatic cancer and a history of previous malignancy.

Approximately 10% of pancreatic adenocarcinoma (PC) cases are attributed to hereditary causes. Individuals with PC and a personal history of another cancer associated with hereditary breast and ovarian cancer (HBOC) or Lynch syndrome (LS) may be more likely to carry germline mutations. Participants with PC and a history of cancer were selected from a pancreatic disease registry. Of 1296 individuals with PC, 149 had a relevant history of cancer. If banked DNA was available, a multigene panel was performed for individuals who had not 1) previously had a mutation identified through clinical testing or 2) undergone clinical multigene panel testing with no mutations detected. Twenty-two of 124 individuals with PC and another HBOC- or LS-related cancer who underwent genetic testing had a mutation identified in a PC susceptibility gene (18%). If prostate cancer is excluded, the mutation prevalence increased to 23% (21/93). Mutation carriers were more likely to have more than 1 previous cancer diagnosis (P = .001), to have had clinical genetic testing (P = .001), and to meet National Comprehensive Cancer Network (NCCN) genetic testing criteria (P < .001). Approximately 23% of mutation carriers did not meet NCCN HBOC or LS testing guidelines based on their personal cancer history and reported cancer history in first-degree relatives. At least 18% of individuals with PC and a personal history of other HBOC- or LS-related cancers carry mutations in a PC susceptibility gene based on our data, suggesting that criteria for genetic testing in individuals with PC should include consideration of previous cancer history. Cancer 2018;124:1691-700. © 2018 American Cancer Society.

Frequency and accuracy of the first-degree family history of cancer in a community-based sample of women with low literacy in the South of Brazil

1549 A positive family history (FH) in first-degree relatives (FDR) is one of the most important risk factors for breast cancer. However, there are few published studies about its prevalence in community-based samples. The aim of this study was to evaluate the prevalence of first-degree cancer FH in an unselected sample of low-literacy women recruited in primary-care health centers through an interview and questionnaire. Accuracy of self- reported cancer history in a FDR was also evaluated. Of 6514 women, 4.5% were illiterate and 66% had elementary education. When asked about cancer FH, 23.3% had at least one FDR with cancer. The accuracy of reported FDR history was evaluated by telephone 12 months after the initial interview. Of the 1516 women reporting at least one FDR with cancer, a random telephone contact was made with 710 (46%). In 88% of the patients, the history reported by phone was exactly the same as the one reported initially. In addition, 29 of 710 patients contacted by phone denied cancer history in FDR. In 7.9% of the patients, FDR history of cancer was confirmed, but one of the following inconsistencies in relation to the original report was described: the type of cancer was different or the relative affected was different. We conclude that a significant proportion of women report history of cancer in a FDR accurately, despite of low literacy. These findings have considerable relevance to clinical practice and are important to validate FH taking in cancer risk estimation models that use this variable. No significant financial relationships to disclose.

Physical Performance Limitations and Participation Restrictions Among Cancer Survivors: A Population-Based Study

Medical late effects among cancer survivors may result in impairments that limit physical performance and activities necessary for normal participation in daily life. The aim of this analysis was to estimate the prevalence of physical performance limitations and participation restrictions among recent (< 5 years since diagnosis), and long-term (> or = 5 years) cancer survivors. Data from the 1999-2002 National Health and Nutrition Examination Survey were analyzed to compare the proportions of physical performance limitations and participation restrictions among 279 recent and 434 long-term cancer survivors, and among 9370 persons with no reported cancer history. Multivariable logistic regression was used to calculate adjusted prevalence odds ratios. Physical performance limitations were 1.5-1.8 times (53% versus 21%) and participation restrictions 1.4-1.6 times (31% versus 13%) more prevalent in cancer survivors than in those with no cancer history. Recent cancer history was associated with increased prevalence of physical performance limitation and participation restriction, particularly in survivors aged 40-49 years. Over half of the cancer survivors reported physical performance limitations; one third reported participation restrictions. Deficits were present many years following cancer diagnosis, even among survivors who were not elderly. Cancer survivors may benefit from evaluation for rehabilitation services long after treatment for their original disease.

Breast Self-Examination among College Women: Predictors for Cancer Control

Monthly breast self-examination (BSE) to aid in the early diagnosis of breast cancer is advocated for all adult women, but regular and competent practice is unusual. Our purpose was to explore the associations between young women's reported cancer history, BSE training, demographic variables (predictors), self-reported frequency of BSE, BSE skill level, breast lump detection ability, confidence, and anxiety (outcome variables). A general health history questionnaire was administered to 73 female university students, faculty, and staff. BSE skill and detection ability were measured by observation; confidence and anxiety ratings were obtained by interview. BSE frequency was predicted by employment status and cyclically enlarged breasts, while BSE skill was related to professional BSE training and the length of that training plus bra size. Surprisingly, BSE training was not found to be associated with self-reported BSE frequency. These analyses suggest that BSE training may result in more complete BSE (although well below acceptable standards) performed by women who are moderately confident and sensitive to the risk of breast cancer--but not in more frequent BSE.

Early Precursors of Urogenital Cancers in Former College Men

Physical and social characteristics recorded at college physical examination or reported at subsequent alumni questionnaire in 1962 or 1966 by 47,271 male former students from Harvard University and the University of Pennsylvania were reviewed for their relationship to risk for cancers of the kidney, bladder, prostate and testis. The records of 213 subjects who died with 1 of these cancers in a 16-50 year followup period and of 280 subjects who reported such a cancer by mail questionnaire in 1976 or 1977 were compared with those of 1,972 matched classmates who were known to be alive and cancer-free at the time subjects with cancer had died or were diagnosed. Students with a record of proteinuria at college physical examination experienced increased risk of kidney cancer. Higher levels of body weight during college were associated with elevated risks of kidney and bladder cancers; however, increased weight in 1962/1966 related only to kidney cancer. A history of cigarette smoking as reported by questionnaire in 1962/1966 predicted increased occurrence of bladder cancer. Students with a history of tonsillectomy at college entrance experienced increased risk of prostate cancer, and those who reported cancer history in 1 or both parents were at increased risk for testicular cancer. These and other findings are presented as clues deserving further exploration for any etiological significance they may hold for the cancer sites studied.