Risk perception and concern among brothers of men with prostate carcinoma

Distrustful Complacency and the COVID-19 Vaccine: How Concern and Political Trust Interact to Affect Vaccine Hesitancy

We test the hypothesis that COVID-19 vaccine hesitancy is attributable to distrustful complacency-an interactive combination of low concern and low trust. Across two studies, 9,695 respondents from different parts of Britain reported their level of concern about COVID-19, trust in the UK government, and intention to accept or refuse the vaccine. Multilevel regression analysis, controlling for geographic area and relevant demographics, confirmed the predicted interactive effect of concern and trust. Across studies, respondents with both low trust and low concern were 10%-22% more vaccine hesitant than respondents with either high trust or high concern, and 26%-29% more hesitant than respondents with both high trust and high concern. Results hold equally among White, Black, and Muslim respondents, consistent with the view that regardless of mean-level differences, a common process underlies vaccine hesitancy, underlining the importance of tackling distrustful complacency both generally and specifically among unvaccinated individuals and populations.

Predictors of perceived risk in first-degree relatives of patients with rheumatoid arthritis

OBJECTIVES

To define variables associated with perceived risk of developing rheumatoid arthritis (RA) in first-degree relatives (FDRs) of patients with RA.

METHODS

Patients with RA and their FDRs were invited to complete cross-sectional surveys. FDR and index patient responses were linked. FDRs' perceived absolute risk, comparative risk, experiential risk and worry about risk were assessed using 5-point Likert scales. FDR predictor variables included demographics, illness perceptions and psychosocial variables. Patient predictors of FDR perceived risk were assessed. Binary logistic regression examined the relationship between FDR characteristics and perceived risk of RA. Generalised estimating equations assessed whether patient variables predicted FDR's perceived risk.

RESULTS

396 FDRs returned a survey. 395 FDRs provided sufficient data and were included in analysis. Paired data from 213 patients were available for 291 of these FDRs. All measures of perceived risk were inter-correlated. 65.2% of FDRs perceived themselves to be 'likely' or 'very likely' to develop RA in their lifetime. Relationship with index patient, high health anxiety, female gender, long perceived RA duration, high perceived concern about RA, negative perceived emotional impact of RA and low perceptions of how well treatment would control RA were all associated with increased FDRs' perceived risk. Patient characteristics did not associate with FDRs' risk perceptions.

CONCLUSIONS

FDRs' perceived risk of RA was high. Key predictors included being a child of a patient with RA, higher health anxiety and lower perceptions of RA treatment control. An understanding of these predictors will inform the development of tailored risk communication resources and preventive clinical strategies for RA.

Motivation for weight loss among completers of a free community-based weight loss program in a US-Mexico border region: A self-determination theory perspective

This study explores the perceptions and motivation for weight loss among participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border using a Self-Determination Theory (SDT) perspective. This manuscript is timely as qualitative research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is currently lacking. Individual semi-structured interviews were conducted with 20 participants (80%, n = 16 female) who completed a community weight-loss intervention to assess motivation for weight loss and participating, and the role of social support and self-efficacy in weight loss. Directed content analysis was used with SDT guiding the questions and subsequent theme analysis. The findings communicate perspectives of participants relevant to 8 prominent themes. The regulation types and constructs related to SDT included: non-regulation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation as well as competence and relatedness. Participants mentioned external sources of motivation, such as wanting to improve their physical appearance, and motivation due to financial incentives. Fewer participants reported intrinsic motivators, which the literature suggests are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively and sustain weight loss. A greater emphasis during weight loss programs on the motives for individuals to lose weight may help improve outcomes in weight-loss interventions. Additionally, increasing strategies targeted at enhancing intrinsic motivation for weight loss may be beneficial.

Health-related and cancer risk concerns among siblings of childhood cancer survivors: a report from the Childhood Cancer Survivor Study (CCSS)

OBJECTIVE

To characterize the prevalence and predictors of concerns regarding future health and cancer risk among siblings of childhood cancer survivors.

METHODS

This study reports longitudinal data (baseline and follow-up) from 3969 adult siblings (median age = 29 [range 18-56] years) of long-term survivors of childhood cancer (median time since diagnosis 19.6 [9.6-33.8] years). Self-reported future health and cancer risk concerns (concerned vs not concerned) were assessed. Demographics and health data reported by both the siblings and their matched cancer survivors were examined as risk factors for health concerns using multivariable logistic regression.

RESULTS

Percentage of siblings reporting future health and cancer risk concerns, respectively, decreased across decade of survivors' diagnosis: 1970s (73.3%; 63.9%), 1980s (67.2%; 62.6%), and 1990s (45.7%; 52.3%). Risk factors associated with future health concerns included sibling chronic health conditions (grade 2 Odds Ratio [OR]=1.57, 95% CI: 1.12-2.20; grades 3-4 OR=1.86, 95% CI: 1.18-2.94; compared to less than grade 2). Risk factors associated with future cancer concerns included sibling chronic health conditions (grade 2 OR=1.43, 95% CI: 1.05-1.94; grades 3-4 OR=1.64, 95% CI: 1.09-2.47; compared to less than grade 2).

CONCLUSIONS

Sibling concerns regarding future health and cancer have diminished in recent decades. There are subgroups of siblings that are at-risk for future health and cancer risk concerns.

IMPLICATIONS FOR CANCER SURVIVORS

Routine screening of concerns in at-risk siblings of survivors of childhood cancer may benefit the siblings of cancer survivors. These individuals may benefit from early interventions during diagnosis and treatment of their siblings.

Risk perception and psychological morbidity in men at elevated risk for prostate cancer

OBJECTIVE

As prostate-specific antigen (psa) makes prostate cancer (pca) screening more accessible, more men are being identified with conditions that indicate high risk for developing pca, such as elevated psa and high-grade intraepithelial neoplasia (hgpin). In the present study, we assessed psychological well-being and risk perception in individuals with those high-risk conditions.

METHODS

A questionnaire consisting of a psychological symptom survey, a trait risk-aversion survey, and a cancer-specific risk perception survey was administered to 168 patients with early-stage localized pca and 69 patients at high risk for pca (n = 16 hgpin, n = 53 psa > 4 ng/mL). Analysis of variance was used to examine differences in psychological well-being and appraisal of risk between the groups.

RESULTS

Compared with the pca group, the high-risk group perceived their risk of dying from something other than pca to be significantly lower (p = 0.007). However, pca patients reported significantly more clinically important psychological symptoms.

CONCLUSIONS

The identification of prostate conditions that predict progression to cancer might not result in the psychological symptoms commonly experienced by pca patients, but does appear to be related to a distorted perception of the disease's mortal risk. Patients with pca experience reduced psychological well-being, but better understand the risks of pca recurrence and death. Education on the risks and outcomes of pca can help at-risk men to view health assessments with reduced worry.

The psychological impact of undergoing genetic-risk profiling in men with a family history of prostate cancer

BACKGROUND

The ability to identify men at genetically high-risk of prostate cancer (PrCa) would enable screening to be targeted at those most in need. This study explored the psychological impact (in terms of general and PrCa-specific worry and risk perceptions) on men with a family history of PrCa, undergoing prostate screening and genetic-risk profiling, within a research study.

METHODS

A prospective exploratory approach was adopted, incorporating a sequential mixed-method design. Questionnaires were completed at two time points to measure the impact of undergoing screening and genetic-risk profiling. In-depth interviews were completed in a subgroup after all study procedures were completed and analysed using a framework approach.

RESULTS

Ninety-five men completed both questionnaires, and 26 were interviewed. No measurable psychological distress was detectable in the group as a whole. The interview findings fell into two categories: 'feeling at risk' and 'living with risk'. The feeling of being at risk of PrCa is a part of men's lives, shaped by assumptions and information gathered over many years. Men used this information to communicate about PrCa risk to their peers. Men overestimate their risk of PrCa and have an innate assumption that they will develop PrCa. The interviews revealed that men experienced acute anxiety when waiting for screening results.

CONCLUSIONS

Personalised genetic-risk assessments do not prevent men from overestimating their risk of PrCa. Screening anxiety is common, and timeframes for receiving results should be kept to a minimum. Methods of risk communication in men at risk of PrCa should be the subject of future research.

Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives

PURPOSE

First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity.

DESIGN

A cross-sectional, qualitative study design was used.

SETTING

Study setting was a cancer center in southwest Florida.

PARTICIPANTS

The study comprised 44 participants (24 PC patients and 20 unaffected FDRs).

METHOD

Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods.

RESULTS

Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than one separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM.

CONCLUSION

Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway.

Latino men and familial risk communication about prostate cancer

PURPOSE/OBJECTIVES

To investigate how familial communication about prostate cancer (PCa) risk and screening affects sons of men with PCa.

RESEARCH APPROACH

Qualitative grounded theory.

SETTING

Southern California.

PARTICIPANTS

17 Latino sons of PCa survivors.

METHODOLOGIC APPROACH

The team conducted semistructured interviews and follow-up interviews. Therefore, the sample includes 25 transcripts. Data were analyzed with a mix of a priori topical codes and grounded theory techniques.

FINDINGS

Sons were in need of information about familial risk and screening options. They became sensitized to PCa, desired information, and held protective intentions. Hopeful intentions came up against cultural taboos around sex, reproductive health, and intimacy that limited discussions between fathers and sons. Fathers were a valued source of information but play various roles, which affect sons' screening intentions. Open communication between father and son promoted awareness of screening and familial risk.

CONCLUSIONS

Uncertainty about familial risk and screening options, especially early detection strategies, was exacerbated by cultural taboos around PCa. Fathers could have been primary and credible advocates for shared decision making, but sons had difficulty learning from their fathers' experience.

INTERPRETATION

FINDINGS from the study can help inform community-based interventions with Latino families, help to culturally tailor health messaging, and sensitize clinicians to a group that needs concerted counseling about PCa risk and screening.

Does concern motivate behavior change? Exploring the relationship between physical activity and body mass index among low-income housing residents

OBJECTIVE

To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population.

METHOD

A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were conducted in 2012 for each concern, using SAS version 9.2.

RESULTS

Those very/moderately concerned about weight were more likely to have higher BMIs, be in the preparation/action stage, received behavioral counseling, participated in a weight management program, and be interested in participating in one in the future. Those very/moderately concerned about physical activity were more likely to have higher BMIs, received behavioral counseling, and participated in a physical activity program.

CONCLUSION

Individuals with elevated BMIs or low levels of physical activity are concerned. While level of concern is important, these findings suggest that it is not likely to be a sufficient catalyst to behavior change.

Psychological aspects of prostate cancer: a clinical review

Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.

Are we worrying about the right men and are the right men feeling worried? Conscious but not unconscious prostate anxiety predicts screening among men from three ethnic groups

Anxieties regarding cancer and screening have been consistently linked in prostate screening behavior with cancer-related anxieties generally thought to be higher among minority men. To date, however, the literature linking cancer anxieties to screening among diverse men remains predicated on self-reported anxiety. Research has yet to consider how "accurate" the reporting of anxiety may be among distinct groups of men or the possibility that anxiety may influence prostate cancer (PC) screening behavior through conscious and nonconscious channels; the current study tested for discrepancies between self-report and Stroop-ascertained general- and prostate-specific anxiety and their links to screening among 180 U.S.-born African American, U.S.-born European American, and immigrant Jamaican men. Men provided self-report information regarding trait and prostate-related anxiety and completed an emotional Stroop task. Mixed model ANOVAs showed that while U.S.-born African Americans had few discrepancies between self-report and Stroop-ascertained anxiety, Jamaicans reported greater PC anxiety than indicated by Stroop performance, while the opposite was true among U.S.-born Europeans. As expected, self-reported (but not Stroop-ascertained) PC anxiety predicted screening in multivariate analysis. Although men from different age and ethnic groups varied in the discrepancy between self-reported and Stroop-ascertained PC anxiety, the influence of avoidance-producing emotions appears to operate predominantly through conscious channels.

Factors influencing cancer risk perception in high risk populations: a systematic review

Background

Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history.

Methods

We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk.

Results

Of 1028 titles identified, 53 articles met our criteria. Most (92%) used an observational design and focused on women (70%) with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups) and few employed theory-driven analytic strategies to decipher interrelationships of factors.

Conclusions

Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although evolving, is still relatively undeveloped in several key topic areas including cancers other than breast and in specific populations. Future rigorous risk perception research using experimental designs and focused on cancers other than breast would advance the field.

Coping with ovarian cancer risk: The moderating effects of perceived control on coping and adjustment

OBJECTIVE

Although perceived control and coping have been studied across various health conditions, these relationships have been less well studied in the context of coping with cancer risk over time. The present study was a longitudinal study of the effects of perceived control and problem-focused coping on changes in psychological adjustment and behavioural outcomes among women at increased risk for ovarian cancer.

DESIGN AND METHODS

Eighty women enrolled in a familial cancer risk assessment programme participated in this study. Assessments of problem-focused coping, perceived control and distress were collected upon entry into the programme and again at 3-month follow-up. Behavioural adherence to screening during the 12-month period following programme entry was obtained from clinic records.

RESULTS

Using hierarchical regression analysis, we observed a significant interaction between perceived control and problem-focused coping for psychological distress, beta=0.94, p<.05. Specifically, problem-focused coping was associated with increasing distress over time among women who perceived high control. A significant control by coping interaction was also observed for behavioural adherence to pelvic ultrasound and CA125 screening, such that women who perceived high control and utilized problem-focused coping were less likely to undergo screening.

CONCLUSIONS

Under conditions of high perceived control, problem-focused coping was associated with increasing distress as well as poorer behavioural adherence. Thus, perceived control and problem-focused coping may not always yield positive psychological or behavioural health outcomes. These findings contribute to a greater understanding of how problem-focused coping and perceived control may influence the course of adjustment to cancer risk over time.

A review of prostate-specific antigen screening prevalence and risk perceptions for first-degree relatives of men with prostate cancer

First-degree relatives of men with prostate cancer have a higher risk of being diagnosed with prostate cancer than men without a family history. The present review examines the prevalence and predictors of testing in first-degree relatives, perceptions of risk, prostate cancer knowledge and psychological consequences of screening. Medline, PsycInfo and Cinahl databases were searched for articles examining risk perceptions or screening practices of first-degree relatives of men with prostate cancer for the period of 1990 to August 2007. Eighteen studies were eligible for inclusion. First-degree relatives participated in prostate-specific antigen (PSA) testing more and perceived their risk of prostate cancer to be higher than men without a family history. Family history factors (e.g. being an unaffected son rather than an unaffected brother) were consistent predictors of PSA testing. Studies were characterized by sampling biases and a lack of longitudinal assessments. Prospective, longitudinal assessments with well-validated and comprehensive measures are needed to identify factors that cue the uptake of screening and from this develop an evidence base for decision support. Men with a family history may benefit from targeted communication about the risks and benefits of prostate cancer testing that responds to the implications of their heightened risk.

Fear, knowledge, and efficacy beliefs differentially predict the frequency of digital rectal examination versus prostate specific antigen screening in ethnically diverse samples of older men

Emotional and cognitive characteristics have been studied in the context of women's cancer screening but have received scant attention in the study of men's screening behavior. Researchers know little about how such factors interact to predict screening or whether digital rectal examination (DRE) and prostate specific antigen (PSA) screens are predicted by the same characteristics. This study examines the relevance of emotional and cognitive characteristics to DRE and PSA screening among 180 U.S.-born African American, U.S.- born European American, and immigrant Jamaican men. The study identifies the expected effects in which fear is negatively related and efficacy beliefs positively related to DRE and PSA screening. Greater efficacy and (marginally) knowledge appear to "offset" the negative impact of fear on screening, and fear appears particularly relevant to DRE frequency. Results are discussed in terms of their implications for the development of health belief and self-regulatory models in the context of prostate cancer screening among minority men.

Provision of a wildfire risk map: informing residents in the wildland urban interface

Wildfires in the wildland urban interface (WUI) are an increasing concern throughout the western United States and elsewhere. WUI communities continue to grow and thus increase the wildfire risk to human lives and property. Information such as a wildfire risk map can inform WUI residents of potential risks and may help to efficiently sort mitigation efforts. This study uses the survey-based contingent valuation (CV) method to examine annual household willingness to pay (WTP) for the provision of a wildfire risk map. Data were collected through a mail survey of the East Mountain WUI area in the State of New Mexico (USA). The integrated empirical approach includes a system of equations that involves joint estimation of WTP values, along with measures of a respondent's risk perception and risk mitigation behavior. The median estimated WTP is around U.S. $12 for the annual wildfire risk map, which covers at least the costs of producing and distributing available risk information. Further, providing a wildfire risk map can help address policy goals emphasizing information gathering and sharing among stakeholders to mitigate the effects of wildfires.

Investigating the effects of cancer risk and efficacy perceptions on cancer prevention adherence and intentions

This study examined the interaction between comparative cancer risk and efficacy perceptions on individuals' adherence for colon, prostate, and breast cancer screenings, intentions to get these screenings in the future, and intentions to adopt health lifestyle behaviors in the next year. A national probability sample of 2,226 adults ages 40 to 70 was surveyed. Overall, a positive interaction effect was found between comparative risk and efficacy on several outcomes. There were some methodological limitations worth noting, but the findings do have implications for health campaigns, particularly the need to increase efficacy beliefs about reducing cancer risks within the general population.

Psychosocial factors associated with an increased frequency of prostate cancer screening in men ages 40 to 79 years: the Olmsted County study

Prostate cancer is the second leading cause of cancer deaths among U.S. men. Early detection is associated with drastically improved 5-year survival rates. It is unclear, however, what psychosocial factors motivate or discourage men from taking advantage of both prostate-specific antigen (PSA) testing and digital rectal examination (DRE). The goal of the current study was to identify psychosocial factors that influence screening behavior for prostate cancer in a cohort of 2,447 men. In 1990, a randomly selected cohort of Caucasian men, ages 40 to 79 years, from Olmsted County, Minnesota, were enrolled in the study. These men completed a questionnaire containing queries on family history of prostate cancer, concern about getting prostate cancer, and marital status. Medical and laboratory records were reviewed to determine the number DREs (1989-1996) and PSA tests (1989-1998). Frequent screening was defined as the upper 25th percentile for number of DREs (>4) or PSAs (>3). Men who have a family history and men who worry or have concern about prostate cancer were more likely [odds ratio (OR), 1.5; 95% confidence interval (95% CI), 1.2-2.0 and OR, 1.9; 95% CI, 1.4-2.5] to seek screening compared with those without a family history or worry. The association between family history and frequent screening was similar in men who were married or living with someone (OR, 1.7; 95% CI, 1.2-2.2); however, it was reduced among men who live alone (OR, 0.6; 95% CI, 0.2-1.8). These data suggest that psychosocial factors such as family history, worry, or concern about prostate cancer and marital status may play an important role in men's decisions about prostate cancer screening.

An object lesson: source determines the relations that trait anxiety, prostate cancer worry, and screening fear hold with prostate screening frequency

Fears regarding prostate cancer and the associated screening are widespread. However, the relations between anxiety, cancer worry, and screening fear and screening behavior are complex, because anxieties stemming from different sources have different effects on behavior. In differentiating among anxieties from different sources (trait anxiety, cancer worry, and screening fear), we expected that cancer worry would be associated with more frequent screening, whereas fear of screening would be associated with less frequent screening. Hypotheses were tested in a sample of 533 men (ages 45-70 years) recruited using a stratified cluster-sampling plan. Men provided information on demographic and structural variables (age, education, income, marital status, physician discussion of risk and screening, access, and insurance) and completed a set of anxiety measures (trait anxiety, cancer worry, and screening fear). As expected, two-step multiple regressions controlling for demographics, health insurance status, physician discussion, and health-care system barriers showed that prostate-specific antigen and digital rectal examination frequencies had unique associations with cancer worry and screening fear. Specifically, whereas cancer worry was associated with more frequent screening, fear of screening was associated with less frequent screening at least for digital rectal examination; trait anxiety was inconsistently related to screening. Data are discussed in terms of their implications for male screening and the understanding of how anxiety motivates health behaviors. It is suggested that understanding the source of anxiety and the manner in which health behaviors such as cancer screenings may enhance or reduce felt anxiety is a likely key to understanding the associations between anxiety and behavioral outcomes.

Risk perceptions and worry about cancer: does gender make a difference?

Risk perceptions and worry are important constructs in many theoretical frameworks used to develop cancer screening interventions. Because most cancers for which we have early detection or prevention strategies are gender specific, few investigations have examined gender differences. We examined gender differences in the magnitude of, and associations with, perceived risk and worry by cancer type. Our sample included 939 men and 1,580 women >or= 50 years old with no history of relevant cancers from the 2003 Health Information National Trends Survey (HINTS). Dependent variables included absolute and comparative perceived risk and worry for gender-specific (breast/prostate) and colon cancers. We examined demographics, health status, health behaviors, cancer beliefs, and cancer communication variables as correlates. Linear regression analyses and pairwise contrasts were conducted with SUDAAN. Men reported greater comparative perceived risk for developing cancers, whereas women reported more frequent cancer worry. For both genders, perceived risk and worry were lowest for colon cancer. Correlates of perceived risk and worry varied, and several associations were moderated by gender. Different risk messages and intervention strategies may be needed to influence males' and females' perceived cancer risk and worry. All effect sizes were small, and future prospective research is needed to confirm our findings.

Increased cancer risk for individuals with a family history of prostate cancer, colorectal cancer, and melanoma and their associated screening recommendations and practices

Prostate cancer, colorectal cancer, and melanoma are three malignancies that appear to have strong genetic components that can confer additional risk to family members. Screening tools, albeit controversial, are widely available to potentially aide in early diagnosis. Family members are now more attuned to the risks and benefits of cancer screening, thus, it is imperative that physicians understand the screening tools and how to interpret the information they provide. We reviewed the current literature regarding the cancer risks for individuals with a family history of prostate cancer, colon cancer, and melanoma, the current screening recommendations for family members, and actual screening practices of individuals with a family history of these malignancies. This review should serve as a guide for physicians and cancer control planners when advising their patients and the public regarding screening decisions.

Number of siblings and the risk of solid tumours: a nation-wide study

We analysed the effects of number of siblings on the risk of solid tumours using the Swedish Family-Cancer Database, including population-based information on over 11 million individuals and more than 178 000 cancer patients diagnosed between 1958 and 2004. Incidence rate ratios (RRs), estimated by Poisson regression models, were adjusted for age, sex, birth cohort, area of residence and socioeconomic status. Having eight or more siblings vs none increased the risk of stomach cancer (RR=1.83, 95% confidence interval (CI), 1.44–2.34). Anal cancer diagnosed before age 40 showed the strongest association with the total siblings (RR=3.27, 95% CI, 2.04–5.26 for five or more siblings vs none). Endometrial (RR=0.76, 95% CI, 0.70–0.82), testicular (RR=0.71, 95% CI, 0.62–0.82), skin cancer (RR=0.82, 95% CI, 0.69–0.97) and melanoma (RR=0.72, 95% CI, 0.65–0.79) showed strong decreased risks for five or more siblings vs none. Prostate cancer risk for those with five or more older siblings vs none was 1.38 (95% CI, 1.23–1.55). Having five or more younger siblings was most strongly associated with stomach cancer (RR=1.59, 95% CI, 1.29–1.95) and melanoma (RR=0.68, 95% CI, 0.59–0.79). We conclude that sibship characteristics are strong correlates of cancer risk at several sites; plausible interpretations include socioeconomic status.

Prostate cancer screening behavior in men from seven ethnic groups: the fear factor

Rates of prostate cancer screening are known to vary among the major ethnic groups. However, likely variations in screening behavior among ethnic subpopulations and the likely role of psychological characteristics remain understudied. We examined differences in prostate cancer screening among samples of 44 men from each of seven ethnic groups (N = 308; U.S.-born European Americans, U.S.-born African Americans, men from the English-speaking Caribbean, Haitians, Dominicans, Puerto Ricans, and Eastern Europeans) and the associations among trait fear, emotion regulatory characteristics, and screening. As expected, there were differences in the frequency of both digital rectal exam (DRE) and prostate-specific antigen (PSA) tests among the groups, even when demographic factors and access were controlled. Haitian men reported fewer DRE and PSA tests than either U.S.-born European American or Dominican men, and immigrant Eastern European men reported fewer tests than U.S.-born European Americans; consistent with prior research, U.S.-born African Americans differed from U.S.-born European Americans for DRE but not PSA frequency. Second, the addition of trait fear significantly improved model fit, as did the inclusion of a quadratic, inverted U, trait fear term, even where demographics, access, and ethnicity were controlled. Trait fear did not interact with ethnicity, suggesting its effect may operate equally across groups, and adding patterns of information processing and emotion regulation to the model did not improve model fit. Overall, our data suggest that fear is among the key psychological determinants of male screening behavior and would be usefully considered in models designed to increase male screening frequency.

Feasibility of familial PSA screening: psychosocial issues and screening adherence

This study examined factors that predict psychological morbidity and screening adherence in first-degree relatives (FDRs) taking part in a familial PSA screening study. Prostate cancer patients (index cases - ICs) who gave consent for their FDRs to be contacted for a familial PSA screening study to contact their FDRs were also asked permission to invite these FDRs into a linked psychosocial study. Participants were assessed on measures of psychological morbidity (including the General Health Questionnaire; Cancer Worry Scale; Health Anxiety Questionnaire; Impact of Events Scale); and perceived benefits and barriers, knowledge; perceived risk/susceptibility; family history; and socio-demographics. Of 255 ICs, 155 (61%) consented to their FDRs being contacted. Of 207 FDRs approached, 128 (62%) consented and completed questionnaires. Multivariate logistic regression revealed that health anxiety, perceived risk and subjective stress predicted higher cancer worry (P = 0.05). Measures of psychological morbidity did not predict screening adherence. Only past screening behaviour reliably predicted adherence to familial screening (P = 0.05). First-degree relatives entering the linked familial PSA screening programme do not, in general, have high levels of psychological morbidity. However, a small number of men exhibited psychological distress.

Identifying Susceptibility Genes for Prostate Cancer--A Family-Based Association Study of Polymorphisms in CYP17, CYP19, CYP11A1, and LH-

Polymorphisms in genes that code for enzymes or hormones involved in the synthesis and metabolism of androgens are compelling biological candidates for prostate cancer. Four such genes, CYP17, CYP19, CYP11A1, and LH-beta, are involved in the synthesis and conversion of testosterone to dihydrotestosterone and estradiol. In a study of 715 men with and without prostate cancer from 266 familial and early-onset prostate cancer families, we examined the association between prostate cancer susceptibility and common single-nucleotide polymorphisms in each of these four candidate genes. Family-based association tests revealed a significant association between prostate cancer and a common single-nucleotide polymorphism in CYP17 (P=0.004), with preferential transmission of the minor allele to unaffected men. Conditional logistic regression analysis of 461 discordant sibling pairs from these same families reaffirmed the association between the presence of the minor allele in CYP17 and prostate cancer risk (odds ratio, 0.51; 95% confidence interval, 0.28-0.92). These findings suggest that variation in or around CYP17 predicts susceptibility to prostate cancer. Family-based association tests may be especially valuable in studies of genetic variation and prostate cancer risk because this approach minimizes confounding due to population substructure, which is of particular concern for prostate cancer given the tremendous variation in the worldwide incidence of this disease.

Positive family history of prostate cancer not associated with worse outcomes after radical prostatectomy

OBJECTIVES

To determine the clinical outcomes in men with (FH) and without (NFH) a family history of prostate cancer after radical prostatectomy.

METHODS

We performed a retrospective analysis of 557 men with localized prostate cancer treated by radical prostatectomy between 1989 and 2000. We defined a positive FH as having one or more first-degree relatives such as a father or brother with prostate cancer. The clinical and pathologic features, as well as biochemical disease-free survival, defined as an undetectable prostate-specific antigen level (less than 0.2 ng/mL), were compared between the FH and NFH groups.

RESULTS

Compared with the NFH group, the FH men were younger at surgery (median 62 years versus 64 years, P = 0.01), had a lower median preoperative prostate-specific antigen level (7.2 ng/mL versus 7.8 ng/mL, P = 0.05), and were more likely to have only low-grade disease at the final pathologic evaluation (26.2% versus 17.8%, P = 0.05). At a median follow-up of 7.5 years (mean 7.6 +/- 2.9 years), 17% of the FH group had biochemical disease recurrence compared with 30% in the NFH group. The actuarial disease-free survival rate at 5 and 10 years for the two groups was 86% and 80% compared with 73% and 66%, respectively (P = 0.01). When controlled for pathologic variables in a multivariate analysis, FH was not an independent predictor of disease-free survival.

CONCLUSIONS

The association of improved disease-free survival in the FH patients may have been driven by an earlier age at diagnosis and more favorable pathologic features.