Associations among family history of cancer, cancer screening and lifestyle behaviors: a population-based study

Abstract

Purpose: Some cancers are largely preventable through modification of certain behavioral risk factors and preventive screening, even among those with a family history of cancer. This study examined the associations between (1) family cancer history and cancer screening, (2) family history and cancer preventive lifestyle behaviors, and (3) cancer screening and lifestyle behaviors.

Methods: Data were from the 2009 California Health Interview Survey (n = 12,603). Outcomes included screening for breast cancer (BC) and colorectal cancer (CRC) and six cancer preventive lifestyle behaviors, based on World Cancer Research Fund recommendations. Multivariate logistic regression analyses, stratified by gender and race-ethnicity, examined associations. Predicted probabilities of cancer screening by family cancer history, race-ethnicity, and sex were computed.

Results: Family history of site-specific cancer-CRC for men and women, and BC for women-was associated with higher probability of cancer screening for most groups, especially for CRC, but was largely unrelated to other lifestyle behaviors. In the few cases in which family history was significantly associated with lifestyle-for example, physical activity among White and Latino males, smoking among White and Asian females-individuals with a family history had lower odds of adherence to recommendations than those with no family history. Greater overall adherence to lifestyle recommendations was associated with higher odds of up-to-date CRC screening among White and Asian males, and lower odds among Asian females (no significant association with BC screening); this relationship did not vary by family cancer history.

Conclusion: The fact that family history of cancer is not associated with better lifestyle behaviors may reflect shared behavioral risks within families, or the lack of knowledge about how certain lifestyle behaviors impact personal cancer risk. Findings can inform interventions aimed at lifestyle behavioral modification for individuals at increased cancer risk due to family history.

Figure 1. Predicted Probabilities of Cancer Screening by Family History of Site-Specific Cancer

Source: Data come from the California Health Interview Survey (2009) and are weighted to be representative of the state population. Notes: **p< .01, *p < .05, †p < .10 (two-tailed test of family history difference, Bonferroni-adjusted). ^aPredicted probabilities holding the following variables constant at their mean values: age, marital status, education, income, current employment status, housing tenure, rural residence, doctor visit in past year, usual source of care, foreign-born status, English language proficiency ^bUp-to-date with colorectal cancer screening (for adults aged 50–75) defined as one of: fecal occult blood (FOBT) test within past year, or sigmoidoscopy in past 5 years and FOBT in past 2, or colonoscopy within past 10 years. ^cUp-to-date breast cancer screening defined as mammography within the past 2 years for women, aged 40–75. ^dRespondent answered "yes" to the question, "Did your biological father or mother, full brothers or sisters, or biological sons or daughters ever have cancer of any kind?" ^eRespondent reported having a first-degree blood relative who had colorectal or breast cancer, respectively.