Working with a population of individuals at risk for gastrointestinal cancers, researchers at Fox Chase Cancer Center have learned that many people misjudge their actual degree of cancer risk and, therefore, their true need for prevention support. Strategies for accurately assessing cancer risk are critical for appropriately targeting educational, counseling, and diagnostic resources to prevent cancer in as many individuals as possible, the investigators say.
The study, to be presented at the 2009 Annual Meeting of the American Society of Clinical Oncology, evaluated participants in the Gastrointestinal Tumor Risk Assessment Program at Fox Chase.*
With the growth in genetic cancer risk assessment in recent years, Fox Chase clinicians and scientists have seen increasing numbers of patients enrolling in the Center's risk assessment programs, including those for breast, ovarian, melanoma, prostate, and gastrointestinal cancers. Risk for gastrointestinal cancers, the focus of the current study, is established through family and personal histories of gastrointestinal cancers and/or colorectal polyps, as well as genetic testing.
"The goal of our study was to improve how we think about and direct our prevention resources," says Michael Hall, M.D., medical oncologist at Fox Chase and lead author on the study. "We examined clinical cancer prevention needs among individuals seeking gastrointestinal risk evaluation, including in our assessment their estimated personal risk, risk beliefs, and interest in genetic testing."
The study evaluated 398 individuals from 278 families enrolled in the Gastrointestinal Tumor Risk Assessment Program at Fox Chase over a nine-year period. The program provides risk assessment to people seeking evaluation for a risk of a gastrointestinal or related cancer. Participants were required to sign an informed consent and complete a health history questionnaire prior to counseling, education, and genetic services.
Results showed that more than 17 percent of the individuals were at high-risk; 70 percent were at moderate-to-high risk; and 12 percent were at low-risk.
"One of our main findings was that, prior to counseling, individuals in the low-risk group estimated the magnitude of their cancer risk as equal to that of the high-risk group," Hall notes. "Clearly, the first step in offering clinical prevention tools to all of the individuals entering our risk assessment program is to help them to understand their actual level of risk. Only then can we recommend the appropriate prevention support."
In the Fox Chase Gastrointestinal Tumor Risk Assessment Program, low-risk individuals receive risk-factor management counseling and education related to appropriate screening. Those at moderate-to-high or high risk are offered additional prevention tools, such as intensive screening and prophylactic surgery, chemoprevention, and genetic testing.
"Preventing cancer is as important as treating cancer," says Hall, summing up his team's findings. "As information about the genetic causes of many cancers becomes more widely known, motivated people with a varying levels of concern and need come to us for risk assessment. To best serve them, we must be able to gauge their risk accurately in order to maximize the benefits of the prevention tools we offer."
*Abstract: Diverse cancer prevention needs in a population seeking risk assessment for gastrointestinal (GI) cancers. General Poster Session, May 31, 2009.
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