In JAMA this week, a team of US scientists presents findings on the clinical relevance of changes in a person's family history of cancer. To quantify how often clinically significant changes occur in cancer family history throughout adulthood, and how that might change a clinician's recommendations on screening for a particular patient, the researchers examined baseline and follow-up family history data from participants in the Cancer Genetics Network. The retrospective analysis showed that "clinically relevant family history of colorectal, breast, and prostate cancer that would result in recommendations for earlier or intense cancer screening increases between ages 30 and 50 years."
In a related JAMA editorial, Case Western Reserve University's Louise Acheson says a family history of cancer contains important information that helps clinicians stratify their patients' cancer risk. Precise family history for an array of cancer is the basis for "state-of-the-art cancer risk assessment," Acheson says. Evidence as to how clinicians and patients use familial risk information to intensify or change cancer screenings or preventive measures is still being gathered, she adds, and researchers will have to carefully study patients who are recommended for extra preventative measures and screening based on updated family history in order to comprehensively assess the effect of accurate family history on stratification of cancer risk.
Also in JAMA this week, Northwestern University's Karrie Ann Snyder and Rosalind Franklin University's William Pearse write that more attention has been paid in recent years to the fertility complications that can arise as a result of many cancer treatments, and that different consortiums have released guidelines for the preservation of fertility in cancer patients. "In understanding this information exchange and medical decision, researchers and best-practice guidelines have looked to the patient-physician relationship, particularly those relationships between patients and oncologists, as the primary opportunity for patients to become aware of potential fertility complications related to cancer treatment," Snyder and Pearse say. However, research has shown that many clinicians do not have fertility discussions with their patients, limiting the ability of cancer patients to take steps to "safeguard their future fertility potential," the authors add. In light of this, research is being done on the best ways to encourage communication between doctors and patients on this subject.
And finally in JAMA this week, Joan Stephenson reports that FDA recently warned that the use of the diabetes drug pioglitazone for more than one year may be associated with an increased risk of bladder cancer. The warning is based in part on an FDA review of data from an ongoing study that show that there was an increased risk of malignancy in patients with long exposures to the drug, Stephenson says. FDA also reviewed a study conducted in France that suggested that pioglitazone is associated with an increased risk of bladder cancer. France has suspended the use of the drug, and German authorities have warned that it shouldn't be prescribed to new patients, Stephenson adds.