title: Confirmation of family cancer history reported in a population-based survey.
abstract: BACKGROUND
  Knowledge of family cancer history is essential for estimating an individual's cancer risk and making clinical recommendations regarding screening and referral to a specialty cancer genetics clinic. However, it is not clear if reported family cancer history is sufficiently accurate for this purpose.
  
  
  METHODS
  In the population-based 2001 Connecticut Family Health Study, 1019 participants reported on 20 578 first-degree relatives (FDR) and second-degree relatives (SDR). Of those, 2605 relatives were sampled for confirmation of cancer reports on breast, colorectal, prostate, and lung cancer. Confirmation sources included state cancer registries, Medicare databases, the National Death Index, death certificates, and health-care facility records. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for reports on lung, colorectal, breast, and prostate cancer and after stratification by sex, age, education, and degree of relatedness and used to estimate report accuracy. Pairwise t tests were used to evaluate differences between the two strata in each stratified analysis. All statistical tests were two-sided.
  
  
  RESULTS
  Overall, sensitivity and positive predictive value were low to moderate and varied by cancer type: 60.2% and 40.0%, respectively, for lung cancer reports, 27.3% and 53.5% for colorectal cancer reports, 61.1% and 61.3% for breast cancer reports, and 32.0% and 53.4% for prostate cancer reports. Specificity and negative predictive value were more than 95% for all four cancer types. Cancer history reports on FDR were more accurate than reports on SDR, with reports on FDR having statistically significantly higher sensitivity for prostate cancer than reports on SDR (58.9% vs 21.5%, P = .002) and higher positive predictive value for lung (78.1% vs 31.7%, P < .001), colorectal (85.8% vs 43.5%, P = .004), and breast cancer (79.9% vs 53.6%, P = .02).
  
  
  CONCLUSIONS
  General population reports on family history for the four major adult cancers were not highly accurate. Efforts to improve accuracy are needed in primary care and other health-care settings in which family history is collected to ensure appropriate risk assessment and clinical care recommendations.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, EPS/7022, Rockville Pike, Bethesda, MD 20852, USA. maip@mail.nih.gov
authors.forename: Phuong L
authors.initials: PL
authors.lastname: Mai
authors.forename: Anne O
authors.initials: AO
authors.lastname: Garceau
authors.forename: Barry I
authors.initials: BI
authors.lastname: Graubard
authors.forename: Marsha
authors.initials: M
authors.lastname: Dunn
authors.forename: Timothy S
authors.initials: TS
authors.lastname: McNeel
authors.forename: Lou
authors.initials: L
authors.lastname: Gonsalves
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Gail
authors.forename: Mark H
authors.initials: MH
authors.lastname: Greene
authors.forename: Gordon B
authors.initials: GB
authors.lastname: Willis
authors.forename: Louise
authors.initials: L
authors.lastname: Wideroff
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology; D003237:Connecticut / Q000453:epidemiology; D003644:Death Certificates; D005190:Family; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D008499:Medical Records; D006278:Medicare; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000235:genetics; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States