Limitations of family cancer history assessment at initial surgical consultation

PURPOSE: Although important for the diagnosis of familial clustering of col orectal cancer and hereditary nonpolyposis colorectal cancer, the accuracy of familial cancer history assessment in the office setting has been questi oned. Furthermore, there are few publications describing the optimal method for accurately capturing a family cancer history. The purpose of this stud y was to determine how well family cancer history is assessed in patients w ith early age-of-onset colorectal cancer at initial surgical consultation c ompared with a telephone interview and mailed questionnaire. METHODS: Medic al records of patients 40 years old or younger at the time of colorectal ca ncer surgery were reviewed for documentation of family cancer history at in itial surgical consultation. In addition, family cancer history was solicit ed from surviving patients or their next of kin by telephone and a mailed q uestionnaire. The kappa coefficient was used to measure degree of correlati on between family cancer history obtained at initial surgical consultation and subsequent telephone interview and questionnaire. RESULTS: One hundred twenty-five patients were available for analysis. Family cancer history was documented on the initial surgical consultation report in 78 percent of ca ses. Although 31.2 percent were identified as having no family cancer histo ry at initial surgical consultation, this proportion decreased to 13.5 perc ent after telephone interviews and questionnaires. Family history assessmen t at initial surgical consultation also failed to identify 7 of 11 individu als meeting Amsterdam criteria for hereditary nonpolyposis colorectal cance r and 10 of 16 individuals meeting modified clinical criteria for hereditar y nonpolyposis colorectal cancer. CONCLUSIONS: Although family cancer histo ry was commonly obtained during the initial surgical consultation of patien ts with colorectal cancer, there was a tendency to underestimate the extent of familial cancer. A telephone interview and questionnaire conducted at a later date may reveal a more comprehensive family cancer history. This is an important observation, because individuals identified as high-risk for h ereditary nonpolyposis colorectal cancer or familial clustering of colorect al cancer require special consideration with respect to screening, surveill ance, and surgical management.