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      First-degree relatives of cancer patients: a target group for primary prevention? A cross-sectional study

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          Abstract

          Background

          Persons with a first-degree relative (FDR) with cancer are at increased cancer risk. We investigated preventive behaviour, cancer risk perception and readiness to change an unhealthy lifestyle in persons with and without an FDR with cancer.

          Methods

          Using an online questionnaire, we conducted a cross-sectional study in Germany including persons (≥35 years) with an FDR with colorectal, lung, prostate, breast, stomach or cervical/uterine cancer ( n = 621) and persons without cancer in FDRs ( n = 303). Quota sampling ensured similar age and sex distributions in both groups.

          Results

          Unfavourable lifestyle factors were equally common in both groups. The proportion perceiving an increased cancer risk significantly differed ( p < 0.0001) with 4% among respondents without cancer in FDRs and 18% (colorectal cancer) to 30% (stomach cancer) among cancer patients’ relatives. The proportion of smokers ready to quit smoking was significantly higher among those perceiving an increased vs. a lower cancer risk (64 vs. 46%, p = 0.04). There was a similar association for readiness to increase physical activity and consumption of fruits/vegetables and to reduce alcohol consumption.

          Conclusions

          Given the increased risk perception and motivation to change an unhealthy lifestyle, our study provides a strong rationale for research on the effectiveness of lifestyle interventions in cancer patients’ relatives.

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          Most cited references25

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          Unrealistic optimism about susceptibility to health problems.

          In this study, 100 college students compared their own chances of experiencing 45 different health- and life-threatening problems with the chances of their peers. They showed a significant optimistic bias for 34 of these hazards, consistently considering their own chances to be below average. Attempts to account for the amount of bias evoked by different hazards identified perceived controllability, lack of previous experience, and the belief that the problem appears during childhood as factors that tend to increase unrealistic optimism. The investigation also examined the importance of beliefs and emotions as determinants of self-reported interest in adopting precautions to reduce one's risk. It found that: (a) beliefs about risk likelihood, beliefs about risk severity, and worry about the risk all made independent contributions to interest in risk reduction; (b) unrealistic optimism undermined interest in risk reduction indirectly by decreasing worry; and (c) beliefs about risk likelihood and severity were not sufficient to explain the amount of worry expressed about different hazards.
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            Environmental and heritable causes of cancer among 9.6 million individuals in the Swedish Family-Cancer Database.

            The genetic and environmental components in 15 common cancers were estimated using the nationwide Swedish Family-Cancer Database. Tetrachoric correlations were used to describe similarity in cancer liability among family members. Structural equation modeling was used to derive estimates of the importance of genetic and environmental effects. Statistically significant estimates of proportion of cancer susceptibility, accounted for by genetic effects, were obtained for all studied cancers except for leukemia. The estimate was highest in thyroid cancer (53%), followed by tumors at endocrine glands (28%), testis (25%), breast (25%), cervix (22%), melanoma (21%), colon (13%), nervous system (12%), rectum (12%), non-Hodgkin lymphoma (10%), lung (8%), kidney (8%), urinary bladder (7%), stomach (1%) and leukemia (1%). The estimates of shared environmental effects ranged from 0% (cervix) to 15% (stomach). The childhood shared environmental effects were most important in testicular cancer (17%), stomach cancer (13%) and cervix in situ (13%). Our results indicate that environment has a principal causative role in cancer at all studied sites except for thyroid. The relatively large effect of heritability in cancer at some sites, on the other hand, indicates that even though susceptibility genes have been described at many cancer sites, they are likely to explain only part of the genetic effects. Copyright 2002 Wiley-Liss, Inc.
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              Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial.

              We wanted to determine the impact of automated family history assessment and tailored messages for coronary heart disease, stroke, diabetes, colorectal, breast, and ovarian cancer on preventive behaviors compared with a standard preventive message. The study was a cluster-randomized clinical trial that included 41 primary care practices, the majority in the Midwest, using Family Healthware, a self-administered, Web-based tool that assesses familial risk for the diseases and provides personalized risk-tailored messages. Patients in the control group received an age- and sex-specific health message related to lifestyle and screening. Smoking cessation, fruit and vegetable intake, physical activity, aspirin use, blood pressure, and cholesterol and blood glucose screening were assessed at baseline and 6 months after the intervention. Of 4,248 participants, 3,344 (78%) completed the study. Participants were white (91%), female (70%), and insured (97%), and had a mean age of 50.6 years (range 35-65 years). Intervention participants were more likely to increase daily fruit and vegetable consumption from 5 or fewer servings a day to 5 or more servings a day (OR = 1.29; 95% confidence interval [CI], 1.05-1.58) and to increase physical activity (OR = 1.47; 95% CI, 1.08-1.98) to 5 to 6 times a week for 30 minutes or more a week. The absolute differences in proportion were 3% and 4%, respectively. Intervention participants were less likely to move from not having cholesterol screening in the last 5 years to having their cholesterol measured within 5 years (OR = 0.34; 95% CI, 0.17-0.67), with an absolute difference of 15%. Messages tailored to an individual's familial risk for 6 common diseases modestly increased self-reported physical activity and fruit and vegetable intake but reduced the likelihood of receiving cholesterol screening.
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                Author and article information

                Contributors
                +49 0 421 218 56862 , haug@leibniz-bips.de
                Journal
                Br J Cancer
                Br. J. Cancer
                British Journal of Cancer
                Nature Publishing Group UK (London )
                0007-0920
                1532-1827
                21 March 2018
                21 March 2018
                May 2018
                : 118
                : 9
                : 1255-1261
                Affiliations
                [1 ]ISNI 0000 0000 9750 3253, GRID grid.418465.a, Department of Clinical Epidemiology, , Leibniz Institute for Prevention Research and Epidemiology – BIPS, ; Achterstr. 30, 28359 Bremen, Germany
                [2 ]ISNI 0000 0001 2297 4381, GRID grid.7704.4, Faculty of Human and Health Sciences, , University of Bremen, ; Grazer Straße 2, 28359 Bremen, Germany
                [3 ]Department of Public Health and Epidemiology, Kantar Health GmbH, Landsberger Str. 284, 80687 Munich, Germany
                [4 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Department of Molecular Medicine and Surgery, Karolinska Institutet, , Karolinska University Hospital, ; Solna (L1:00), 171 76 Stockholm, Sweden
                Article
                57
                10.1038/s41416-018-0057-2
                5943415
                29559731
                28f19523-eab8-4f50-adaf-28d9435fa575
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 22 September 2017
                : 21 February 2018
                : 22 February 2018
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                © Cancer Research UK 2018

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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