Is it possible that preventive advice is particularly fruitful for relatives of cancer patients? One study suggests that. The circumstance could be used responsibly for cancer prevention.
The cross-sectional study from the environment of the University of Bremen is based on a large-scale anonymous survey. 621 persons with first-degree relatives with cancer and 303 persons without such relatives indicated via online questionnaire,
- to what extent they themselves engage in preventive measures (or what their lifestyle currently looks like),
- how they perceive their cancer risk (compared to the age- and sex-matched general population); and
- whether they are willing to rethink a lifestyle that may be unhealthy.
The age of participation was at least 35 years. This is because, on the one hand, cancer cases in the family become more frequent from this age onwards, and on the other hand, certain preventive examinations (so-called check-ups) are increasingly offered – an opportunity for doctors to have an advisory effect on the patient’s lifestyle. Age was evenly distributed across the two groups, as was the gender of the participants. The cancers in question were colorectal, lung, prostate, breast, stomach and uterine cancers – all tumors with (presumably at least in part) a hereditary genesis, but which in addition can be reduced in frequency by certain preventive lifestyle measures. First and foremost, of course, by abstaining from tobacco and moderate alcohol consumption. The cancer diagnoses were all years in the past, a median of 19 years for parents with the disease and ten for children or siblings with the disease. 142 individuals reported multiple cancers in the family.
“I want to get better”
Unfavorable lifestyle factors such as insufficient exercise, high BMI, or smoking were found equally frequently in both groups. However, the perception of their own risk was significantly more pronounced among relatives of cancer patients. As an example: While only 4% of respondents without family members with cancer assumed an increased risk of cancer for themselves (compared to the average), relatives of colorectal cancer patients did so in 18% of cases and those of gastric cancer patients in 30% of cases.
In terms of willingness and motivation to change something about their unhealthy lifestyle, the trend continued: due to the generally increased perception of a health risk, 64% said they wanted to give up smoking. In contrast, the approval of this preventive measure among respondents who assumed a lower cancer risk was “only” 46% (significant difference of p=0.04). The same relationship was shown regarding willingness to increase consumption of fruits and vegetables and reduce alcohol consumption.
Relatives are receptive to prevention advice….
The authors see their results as an opportunity for improved and more targeted cancer prevention. For example, in family practice, it may be important to actively address and support prevention efforts among relatives of cancer patients – if the primary disease is known in the family. This appears to be a collective that is fundamentally very receptive to changing potential risk behaviors. Given the large number of cancer cases in the population and thus the amount of relatives, even small positive effects of prevention counseling have a strong impact on society as a whole.
Of course, balanced lifestyle advice should not be confused with “scaremongering” and improper communication of disease risks. It should be noted in this context that the assessment of the relatives’ own risk of disease may well be exaggerated and thus incorrect. The study did not map real risks, but assumed ones. It is therefore all the more important to find a balance between preventive counseling and emotional support, so that the patient’s fear of now contracting cancer himself does not falsely take over and cause great psychological stress. In many cases, the hereditary component is only one of numerous (possible) risk factors. Genetic and environmental factors interact, interact and reinforce each other.
…but do not implement them
Unfortunately, good intentions seem to translate poorly into “real” lifestyle changes, as evidenced by the fact that the relatives of cancer patients in the study lived just as unhealthy (or healthy) a lifestyle as their comparison group. In terms of tobacco use, relatives of lung cancer patients actually performed significantly worse (i.e., they smoked more frequently at 38% vs. 26%). It seems that an exceptionally strong stimulus is required for people to take preventive action themselves – a fact that most physicians will be familiar with from their everyday experience and that has also been shown in studies [1–3]. Does the long period since the cancer diagnosis play a role here? Is the window of opportunity for fruitful counseling possibly more likely to be sought in the immediate aftermath of a relative’s illness [4]? Does the “learning effect” thus decline over the years? Or do families simply often share the same risks, such as obesity, smoking, etc., because of social cohesion? Questions to be addressed with a new (intervention) study.
One thing is certain: underestimation or ignorance of one’s own risk – as suspected in earlier studies [1] – cannot have been the reason, at least in the present study. Psychologically, it is thought that one’s risk perception may play a crucial mediating role in initiating preventive lifestyle measures [5]. It is therefore possible that the long period of time since diagnosis was the main reason for the lack of effect on the current lifestyle.
In a nutshell
- Close family members of people with cancer are more motivated to reconsider a high-risk lifestyle.
- This circumstance could be used (responsibly) for cancer prevention.
Source: Haug U, et al: British Journal of Cancer 2018. DOI:10.1038/s41416-018-0057-2. [Epub ahead of Print]
Literature:
- Bostean G, et al: Associations among family history of cancer, cancer screening and lifestyle behaviors: a population-based study. Cancer Causes Control 2013; 24: 1491-1503.
- Townsend JS, et al: Health behaviors and cancer screening among Californians with a family history of cancer. Genet Med 2013; 15: 212-221.
- Madlensky L, et al: Preventive health behaviors and familial breast cancer. Cancer Epidemiol Biomark Prev 2005; 14: 2340-2345.
- Lemon SC, Zapka JG, Clemow L: Health behavior change among women with recent familial diagnosis of breast cancer. Prev Med 2004; 39: 253-262.
- Klein WM, Stefanek ME: Cancer risk elicitation and communication: lessons from the psychology of risk perception. CA Cancer J Clin 2007 May-Jun; 57(3): 147-167.
InFo ONCOLOGY & HEMATOLOGY 2018; 6(5): 3.
