Int J Cancer. 2014 Oct 1. doi: 10.1002/ijc.29243. [Epub ahead of print]
Family history in the finnish prostate cancer screening trial.
Family history (FH) is one of the few known risk factors for prostate cancer (PC). There is also new evidence about mortality reduction in screening of PC with prostate-specific antigen (PSA). Therefore we conducted a prospective study in the Finnish Prostate Cancer Screening Trial to evaluate the impact of family history on outcomes of PC screening. Of the 80,144 men enrolled, 31,866 men were randomized to the screening arm and were invited for screening with PSA test (cut-off 4ng/ml) every 4 years. At the time of the each invitation, family history of prostate cancer (FH) was assessed through a questionnaire. The analysis covered a follow-up to 12 years from randomization for all men with data on family history. Of the 23,702 (74.3%) invited men attending screening, 22,756 (96.0%) provided information of their FH. Altogether 1723 (7.3%) men reported at least one first-degree relative diagnosed with PC and of them 235 (13.6%) were diagnosed with PC. Men with a first-degree FH had increased risk for PC (risk ratio (RR) 1.31, p<0.001) and the risk was especially elevated for interval cancer (RR 1.65, 95% CI 1.27-2.15). Risk for low-grade (Gleason 2-6) tumors was increased (RR 1.46, 95% CI 1.15-1.69), but it was decreased for Gleason 8-10 tumors (RR 0.48, 95% CI 0.25-0.95). PSA test performance (sensitivity and specificity) was slightly inferior for FH positives. No difference in prostate cancer mortality was observed in terms of FH. Our findings provide no support for selective PSA screening targeting men with family history of PC. © 2014 Wiley Periodicals, Inc.
Copyright © 2014 UICC.
early detection of cancer; familial; prostate cancer; prostatic neoplasms; risk factors
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