As Thanksgiving and end-of-year holidays come around the corner, traditions and connections with family and friends come into strong light. A new study published in the Oncology Nursing Forum showed how important family relationships are in getting tested for cancer. Although screenings for common cancers like breast and colorectal cancer are available, multiple barriers limit their uptake, including limited access to care, few referrals from health care providers, and concerns among those at high risk for cancer.
The study team, led by Memnum Seven, RN, PhD, of the Elaine Marieb College of Nursing at the University of Massachusetts Amherst, focused on people considered high-risk for cancer due to having first or second-degree relatives with breast, ovarian, or colorectal cancer. The goal was to understand how their social network characteristics impacted their use of cancer screening and genetic counseling.
Participants were asked questions about their overall social network including structural conditions (place of residence, sociodemographic characteristics), social network (size, density, closeness, sex, and frequency of communication), and psychosocial aspects (emotional closeness, support groups, access to resources, and number of family members with cancer). The primary outcomes were 2 health behaviors: having a cancer screening and having genetic testing and/or counseling.
Of the 170 participants, 19% completed colorectal cancer and 12% completed lung cancer screening. Of the 62% of participants who identified as female, 34% completed breast cancer and 49% completed cervical cancer screening. Participants’ most frequently reported reasons to have cancer screening were (1) to benefit their family’s future (39%) and (2) impact on future health care decisions (39%).
More than half (57%) of participants knew where to get a cancer screening. Participants who had attended any cancer support group were more likely to have undergone a cancer screening, as were women who had a Pap smear and anyone who had a colonoscopy.
Families with stronger closeness were more likely to report undergoing cancer screening. For every 1-unit increase in family social cohesion (on a scale of 0 to 10), there was a 1.26 times greater likelihood of mammography. For colonoscopy screening, for each family member with cancer a participant reported, the likelihood that participant underwent screening increased by 2.4. For genetic testing and counseling, the odds increased for each family member included in the analysis, indicating that larger family social networks increased the likelihood of seeking genetic counseling.
The researchers note that the rates of cancer screening in this sample were lower than national averages, despite these individuals being high-risk for cancer due to having close family members with a cancer diagnosis. Based on the results showing that family size and cohesion may influence rates of screening, they conclude that clinicians and genetic counselors can engage in proactive referral and follow-up within these populations.
One option is to perform cascade genetic testing for those who are blood relatives of individuals with a specific genetic variant (e.g., BRCA1 or BRCA2). Most people share their results of genetic testing related to cancer risk with their first-degree relatives, though less frequently with second- and third-degree relatives. Even after this, the rate of subsequent genetic testing among eligible first-degree relatives was only around 30%.
Nurses and other oncology clinicians can help ensure that individuals who screen and test for cancer risks are given what they need to continue conversations and behaviors within their families. Supporting families to discuss their cancer risks, educating each other on screening options and impacts of family planning and health, and providing support throughout can help mitigate potential barriers to screening. This is particularly true among populations for whom cost, and access may further hinder screening efforts.