共患癌家庭子女相关癌种筛查起始年龄的研究

Study on the screening age of children with diagnosed cancer in either of the parents

目的研究父亲或者母亲与子和(或)女共患癌家庭中,相关各方患癌诊断年龄(统计上即为发病年龄)的特点;探讨在父亲或者母亲患癌家庭中,其子女进行相关癌症筛查的起始年龄。方法收集2008年1月至2018年3月于中国医学科学院肿瘤医院防癌科进行防癌体检的33200人的肿瘤相关家族史等信息,分析父亲或者母亲与儿子和(或)女儿均被诊断为癌症的家庭的诊断年龄特点。父亲、母亲、儿子和女儿诊断年龄的组间比较采用计量资料独立性t检验进行统计分析。结果父亲与子女共患癌家庭480个,共有614对父子(女);母亲与子女共患癌家庭476个,共有614对母子(女),合计956个家庭,儿子505人,女儿723人。父亲与子女共患癌家庭中,父亲、儿子、女儿的诊断年龄分别为(66.6±10.8)、(56.6±11.7)、(51.7±11.7)岁。平均诊断年龄上,儿子早于父亲10.0年、女儿早于父亲14.9年、女儿早于儿子4.9年,差异均有统计学意义(P<0.001)。母亲与子女共患癌家庭中,母亲、儿子与女儿的诊断年龄分别为(65.8±12.2)、(57.8±12.2)和(52.3±12.4)岁。平均诊断年龄上,儿子早于母亲8.0年、女儿早于母亲13.5年、女儿早于儿子5.5年,差异均有统计学意义(P<0.001)。父亲或母亲≤50岁患癌的子女,其平均诊断年龄较父亲或母亲在50岁之后诊断子女分别早4.8和4.4岁,差异均有统计学意义(P<0.05,P<0.001)。儿子和女儿诊断为肺癌的年龄较父亲分别提前9.3岁和12.6岁,较母亲提前10.2岁和13.6岁,差异均有统计学意义(P<0.001)。母亲组女儿诊断为乳腺癌的平均年龄较母亲提前10.5岁,父亲组女儿诊断为乳腺癌的平均年龄较母亲组的母亲提前11.1岁,差异均有统计学意义(P<0.001)。结论父亲或者母亲与子女共患癌的家庭中,其子女尤其是女儿诊断为癌症的年龄明显早于父母患癌的诊断年龄。建议父亲或者母亲患癌的家庭,其子女开始进行相关癌症筛查的年龄较相关指南推荐年龄适当提前。

Objective To determine the screening and early detection reference age for individuals with family history of cancer in either one of the parents.Methods We examined the family history of 33200 subjects who visited the Department of Cancer Prevention,National Cancer Center and Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College between January 2008 and March 2018 for cancer screening and early detection.The age differences between the subjects in the research population were analyzed using an independent t-test.All statistical analysis was performed using IBM SPSS Statistics for Windows version 24.0(IBM Corp.,Armonk,NY,USA).Results We documented 480 families in which fathers and one or more of their children were diagnosed with malignancies,attributing to 614 father-child pairs.We also documented 476 families with mothers and one or more of their children diagnosed with malignancies,attributing to 614 mother-child pairs.In total,we included 956 families in our study with a total of 505 sons and 723 daughters diagnosed with cancer during the study period.In the father-child group the average age at diagnosis for fathers,sons,and daughters were 66.6±10.8,56.6±11.7,and 51.7±11.7 years,respectively.Sons and daughters were diagnosed with malignancy 10.0 and 14.9 years earlier than their fathers,respectively(P<0.001).Daughters developed malignancies approximately 5 years earlier than sons in the father-child group(P<0.001).In the mother-child group,the average age at diagnosis for mothers,sons,and daughters were 65.8±12.2,57.8±12.2,and 52.3±12.4 years,respectively.Mothers were diagnosed with malignant disease 8 years later than their sons(P<0.001)and 13.5 years later than their daughters(P<0.001).Interestingly,daughters developed malignant diseases 5.5 years earlier than sons even in this group(P<0.001).Average age at diagnosis for subjects whose fathers and mothers developed malignancy before 50 years was 4.8 years and 4.4 years earlier than those whose fathers and mothers developed malignancy after 50 years old(P<0.05,P<0.001).Sons and daughters were diagnosed with lung cancer 9.3 and 12.6 years earlier than the fathers,and 10.2 and 13.6 years earlier than the mothers,respectively(P<0.001).The daughters in the mother-children group and the father-daughter group were diagnosed with breast cancer 10.5 and 11.1 years earlier than the mothers in the mother-child group(P<0.001).Conclusions Children develop malignancy earlier than their parents in families with cancer in parents and children.Hence,individuals with a family history of cancer in either of their parents should undergo interventions for cancer screening and early detection at a relatively earlier age compared to the initial screening age recommended by conventional screening guidelines for certain cancers.