Family cancer history and pedigrees as a public health intervention for promoting health and preventing prostate cancer in African-Americans

Prostate cancer is the most common cancer diagnosed in men and the second leading cause of cancer death among men in the United States. African-American men have substantially higher prostate cancer incidence and mortality than European-American men. It is unclear whether this incidence is due to acquired DNA changes (sporadic cancer) or if germline Mendelian genetics/genomics (inherited cancer) is the source of this health disparity. To explore this cause, the focus of this dissertation paper is family health history and hereditary prostate cancer. A family history tool is the most commonly used predictive instrument for hereditary prostate cancer. The identification of men with hereditary prostate cancer allows healthcare providers to identify high-risk relatives who are more likely to benefit from targeted health promotion and cancer prevention programs. Use of non-validated family history tools may prevent healthcare providers from collecting information needed to identify hereditary prostate cancer and ascertaining accurate risk assessment in unaffected African-American men. This pilot study was conducted to validate the effectiveness of a family cancer history tool and pedigree analysis in the identification of hereditary prostate cancer in a community based sample of African-American men. While small sample size limited the power of the analysis, the family history tool and pedigree analysis appears to have analytical validity as a public health instrument for identifying hereditary prostate cancer. Twenty-two percent (11 of 49) of consultands reported a personal history of prostate cancer with one hereditary prostate cancer family observed. Age was significantly related to a personal history of prostate cancer (p= 0.05) but other known predictors of prostate cancer were statistically undetectable. The pilot study demonstrated that though the family cancer history tool appears to have clinical validity a larger sample is needed to prove clinical validity. Additional research is needed to examine analytical validity, clinical utility and ethical, legal and social issues surrounding the use of family cancer history and pedigree analysis as a public health intervention for addressing the health disparity of prostate cancer in African-American men.