Clinically relevant lessons from Family HealthLink: a cancer and coronary heart disease familial risk assessment tool
- Genetics in Medicine
- (2014)
- doi:10.1038/gim.2014.136
- Received
- Accepted
- Published online
Abstract
Purpose:
A descriptive retrospective study was performed using two separate user cohorts to determine the effectiveness of Family HealthLink as a clinical triage tool.
Methods:
Cohort 1 consisted of 2,502 users who accessed the public website. Cohort 2 consisted of 194 new patients in a Comprehensive Breast Center setting. For patient users, we assessed documentation of family history and genetics referral. For all users seen in a genetics clinic, the Family HealthLinkassessment was compared with that performed by genetic counselors and genetic testing outcomes.
Results:
For general public users, the percentage meeting high-risk criteria were: for cancer only, 22.2%; for coronary heart disease only, 24.3%; and for both diseases, 10.4%. These risk stratification percentages were similar for the patient users. For the patient users, there often was documentation of family history of certain cancer types by oncology professionals, but age of onset and coronary heart disease family history were less complete. Of 142 with high-risk assignments seen in a genetics clinic, 130 (91.5%) of these assignments were corroborated. Forty-two underwent genetic testing and 17 (40.5%) had new molecular diagnoses established.
Conclusion:
A significant percentage of individuals are at high familial risk and may require more intensive screening and referral. Interactive family history triage tools can aid this process.
Genet Med advance online publication 30 October 2014
Keywords:
familial; family history; genetic testing; risk assessment; triage
References
- Li R, Bensen JT, Hutchinson RG, et al. Family risk score of coronary heart disease (CHD) as a predictor of CHD: the Atherosclerosis Risk in Communities (ARIC) study and the NHLBI family heart study. Genet Epidemiol 2000;18:236–250.
- Hampel H, Sweet K, Westman JA, Offit K, Eng C. Referral for cancer genetics consultation: a review and compilation of risk assessment criteria. J Med Genet 2004;41:81–91.
- Garber JE, Offit K. Hereditary cancer predisposition syndromes. J Clin Oncol2005;23:276–292.
- Moyer VA. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160:271–281.
- National Comprehensive Cancer Network I. Genetic/Familial High Risk Assessment. NCCN Clinical Practice Guidelines in Oncology, 2012.http://www.nccn.org/professionals/physician_gls/recently_updated.asp. Accessed 2013.
- Scheuner MT, Whitworth WC, McGruder H, Yoon PW, Khoury MJ. Familial risk assessment for early-onset coronary heart disease. Genet Med 2006;8:525–531.
- Morales A, Cowan J, Dagua J, Hershberger RE. Family history: an essential tool for cardiovascular genetic medicine. Congest Heart Fail 2008;14:37–45.
- Sweet KM, Bradley TL, Westman JA. Identification and referral of families at high risk for cancer susceptibility. J Clin Oncol 2002;20:528–537.
- Scheuner MT, McNeel TS, Freedman AN. Population prevalence of familial cancer and common hereditary cancer syndromes. The 2005 California Health Interview Survey. Genet Med 2010;12:726–735.
- Scheuner MT. Genetic evaluation for coronary artery disease. Genet Med 2003;5:269–285.
- Scheuner MT, Whitworth WC, McGruder H, Yoon PW, Khoury MJ. Expanding the definition of a positive family history for early-onset coronary heart disease. Genet Med2006;8:491–501.
- Nagy R, Sweet K, Eng C. Highly penetrant hereditary cancer syndromes. Oncogene2004;23:6445–6470.
- Murabito JM, Pencina MJ, Nam BH, et al. Sibling cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults. JAMA 2005;294:3117–3123.
- Nadir MA, Struthers AD. Family history of premature coronary heart disease and risk prediction. Heart 2011;97:684; author reply 684.
- Rubinstein WS, Acheson LS, O’Neill SM, et al.; Family Healthware Impact Trial (FHITr) Group. Clinical utility of family history for cancer screening and referral in primary care: a report from the Family Healthware Impact Trial. Genet Med 2011;13:956–965.
- Flossmann E, Rothwell PM. Family history of stroke in patients with transient ischemic attack in relation to hypertension and other intermediate phenotypes. Stroke 2005;36:830–835.
- Qureshi N, Armstrong S, Dhiman P, et al.; ADDFAM (Added Value of Family History in CVD Risk Assessment) Study Group. Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care: a matched-pair, cluster randomized trial. Ann Intern Med 2012;156:253–262.
- Valdez R, Yoon PW, Qureshi N, Green RF, Khoury MJ. Family history in public health practice: a genomic tool for disease prevention and health promotion. Annu Rev Public Health 2010;31:69–87, 1 p following 87.
- Wilson BJ, Carroll JC, Allanson J, et al. Family history tools in primary care: does one size fit all? Public Health Genomics 2012;15:181–188.
- Lu KH, Wood ME, Daniels M, et al.; American Society of Clinical Oncology. American Society of Clinical Oncology Expert Statement: collection and use of a cancer family history for oncology providers. J Clin Oncol 2014;32:833–840.
- Kelly KM, Sweet K. In search of a familial cancer risk assessment tool. Clin Genet2007;71:76–83.
- Kroeze W, Werkman A, Brug J. A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med 2006;31:205–223.
- Sweet KM, Willis SK, Ashida S, Westman JA. Use of fear-appeal techniques in the design of tailored cancer risk communication messages: implications for healthcare providers. J Clin Oncol 2003;21:3375–3376.
- Family HealthLink [computer program]. The Ohio State University Wexner Medical Center,2008. https://familyhealthlink.osumc.edu.
- Kreuter MFD, Olevitch L. Tailoring Health Messages—Customizing Communication With Computer Technology. Lawrence Erlbaum Associates: Mahwah, NJ, 2000:145–164.
- Mathews AW. The life-saving secrets in your family tree. Wall Street Journal 11 June 2009.
- Orlando LA, Wu RR, Beadles C, et al. Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand. Am J Med Genet C Semin Med Genet 2014;166C:24–33.
- Saadatmand S, Tilanus-Linthorst MM, Rutgers EJ, et al. Cost-effectiveness of screening women with familial risk for breast cancer with magnetic resonance imaging. J Natl Cancer Inst 2013;105:1314–1321.
- Bender R, Bell DA, Hooper AJ, et al. Screening for familial hypercholesterolaemia.Pathology 2012;44:122–128.
- Brennan P, Claber O, Brennan T. Cancer family history triage: a key step in the decision to offer screening and genetic testing. Fam Cancer 2013;12:497–502.
- Wood ME, Kadlubek P, Pham TH, et al. Quality of cancer family history and referral for genetic counseling and testing among oncology practices: a pilot test of quality measures as part of the American Society of Clinical Oncology Quality Oncology Practice Initiative. J Clin Oncol 2014;32:824–829.
- Vasen HF, Möslein G, Alonso A, et al. Recommendations to improve identification of hereditary and familial colorectal cancer in Europe. Fam Cancer 2010;9:109–115.
- Michos ED, Vasamreddy CR, Becker DM, et al. Women with a low Framingham risk score and a family history of premature coronary heart disease have a high prevalence of subclinical coronary atherosclerosis. Am Heart J 2005;150:1276–1281.
- Kromhout D, Menotti A, Kesteloot H, Sans S. Prevention of coronary heart disease by diet and lifestyle: evidence from prospective cross-cultural, cohort, and intervention studies.Circulation 2002;105:893–898.
- Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000;343:16–22.
- Sweet K, Michaelis, R. The Busy Physician’s Guide to Genetics, Genomics and Personalized Medicine. Springer: Dordrecht, The Netherlands, 2011.
- Acheson LS, Wiesner GL, Zyzanski SJ, Goodwin MA, Stange KC. Family history-taking in community family practice: implications for genetic screening. Genet Med 2000;2:180–185.
- Guttmacher AE, Collins FS, Carmona RH. The family history–more important than ever. N Engl J Med 2004;351:2333–2336.
- Skinner CS, Strecher VJ, Hospers H. Physicians’ recommendations for mammography: do tailored messages make a difference? Am J Public Health 1994;84:43–49.
Author information
Affiliations
Division of Human Genetics, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Kevin Sweet,
- Amy C. Sturm &
- Doreen Agnese
Department of Internal Medicine, Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Amy C. Sturm
Department of Internal Medicine, Stefanie Spielman Comprehensive Breast Center, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Amy Rettig
Department of Internal Medicine, Center for Biostatistics, Department of Biomedical Informatics, Columbus, Ohio, USA
- Joseph McElroy
Division of Surgical Oncology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Doreen Agnese
No hay comentarios:
Publicar un comentario