Purpose: Family history of colorectal cancer (CRC) is a known risk factor for CRC and encompasses both genetic and shared environmental risks. Methods: We conducted a systematic review to estimate the impact of family history on the natural history of CRC and adherence to screening. Results: We found high heterogeneity in family-history definitions, the most common definition being one or more first-degree relatives. The prevalence of family history may be lower than the commonly cited 10%, and confirms evidence for increasing levels of risk associated with increasing family-history burden. There is evidence for higher prevalence of adenomas and of multiple adenomas in people with family history of CRC but no evidence for differential adenoma location or adenoma progression by family history. Limited data regarding the natural history of CRC by family history suggest a differential age or stage at cancer diagnosis and mixed evidence with respect to tumor location. Adherence to recommended colonoscopy screening was higher in people with a family history of CRC. Conclusion: Stratification based on polygenic and/or multifactorial risk assessment may mature to the point of displacing family history–based approaches, but for the foreseeable future, family history may remain a valuable clinical tool for identifying individuals at increased risk for CRC. Genet Med 17 9, 702–712.

Health systems increasingly are exploring implementation of standardized social risk assessments. Implementation requires screening tools both with evidence of validity and reliability (psychometric properties) and that are low cost, easy to administer, readable, and brief (pragmatic properties). These properties for social risk assessment tools are not well understood and could help guide selection of assessment tools and future research. The systematic review was conducted during 2018 and included literature from PubMed and CINAHL published between 2000 and May 18, 2018. Included studies were based in the U.S., included tools that addressed at least 2 social risk factors (economic stability, education, social and community context, healthcare access, neighborhood and physical environment, or food), and were administered in a clinical setting. Manual literature searching was used to identify empirical uses of included screening tools. Data on psychometric and pragmatic properties of each tool were abstracted. Review of 6,838 unique citations yielded 21 unique screening tools and 60 articles demonstrating empirical uses of the included screening tools. Data on psychometric properties were sparse, and few tools reported use of gold standard measurement development methods. Review of pragmatic properties indicated that tools were generally low cost, written for low-literacy populations, and easy to administer. Multiple low-cost, low literacy tools are available for social risk screening in clinical settings, but psychometric data are very limited. More research is needed on clinic-based screening tool reliability and validity as these factors should influence both adoption and utility. This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.

BACKGROUND AND OBJECTIVES: Physicians have a major influence on parental vaccine decisions. We tested a physician-targeted communication intervention designed to (1) reduce vaccine hesitancy in mothers of infants seen by trained physicians and (2) increase physician confidence in communicating about vaccines. METHODS: We conducted a community-based, clinic-level, 2-arm cluster randomized trial in Washington State. Intervention clinics received physician-targeted communications training. We enrolled mothers of healthy newborns from these clinics at the hospital of birth. Mothers and physicians were surveyed at baseline and 6 months. The primary outcome was maternal vaccine hesitancy measured by Parental Attitudes on Childhood Vaccines score; secondary outcome was physician self-efficacy in communicating with parents by using 3 vaccine communication domains. RESULTS: We enrolled 56 clinics and 347 mothers. We conducted intervention trainings at 30 clinics, reaching 67% of eligible physicians; 26 clinics were randomized to the control group. Maternal vaccine hesitancy at baseline and follow-up changed from 9.8% to 7.5% in the intervention group and 12.6% to 8.0% in the control group. At baseline, groups were similar on all variables except maternal race and ethnicity. The intervention had no detectable effect on maternal vaccine hesitancy (adjusted odds ratio 1.22, 95% confidence interval 0.47–2.68). At follow-up, physician self-efficacy in communicating with parents was not significantly different between intervention and control groups. CONCLUSIONS: This physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy. Research is needed to identify physician communication strategies effective at reducing parental vaccine hesitancy in the primary care setting.

Skin cancer is the most commonly diagnosed cancer in the United States. It is an abnormal growth of cells that begins in the outermost (epidermal) layer of the skin and is broadly classified as melanoma and nonmelanoma skin cancer. The incidence of melanoma, the most severe form of skin cancer, has been increasing, but overall melanoma mortality rates have not increased significantly.^1-3 Although 2% of all skin cancers are melanoma, it is estimated to cause more than 80% of skin cancer deaths.^4,5 UV radiation causes most skin cancers through damage to DNA⁶ and represents the major environmental risk factor for all types of skin cancer.^7,8 Five-year survival for melanoma is 98.4% for local-stage disease to 17.9% for distant-stage disease.^9,10 Thus, behavioral counseling promoting behaviors for reducing UV exposure, and skin self-examination to identify and report suspicious lesions, could prevent skin cancer.

Parents who refuse or delay vaccines because of vaccine hesitancy place children at increased risk for vaccine-preventable disease. How parental vaccine hesitancy changes as their children age is not known. In 2015, we conducted a follow-up survey of 237 mothers enrolled in a 2-arm clinic-level cluster randomized trial (n = 488) in Washington State that was completed in 2013. We surveyed mothers at their baby’s birth, age 6 months, and age 24 months using a validated measure of vaccine hesitancy. Both mean hesitancy scores (mean 4.1-point reduction; 95% CI, 2.5-5.6; P = .01) and the proportion of mothers who were vaccine hesitant (9.7% at baseline vs 5.9% at 24 months; P = .01) decreased significantly from child’s birth to age 24 months. Changes from baseline were similar for first-time mothers and experienced mothers. Individual item analysis suggested that the decrease may have been driven by increases in maternal confidence about the safety and efficacy of vaccines. Our results suggest that hesitancy is a dynamic measure that may peak around childbirth and may remit as experience with vaccines accumulates.

Skin cancer is broadly classified as cutaneous melanoma and keratinocyte carcinoma. Keratinocyte carcinomas comprise the vast majority of all incident skin cancers, with basal cell carcinoma making up about 80% of all incident cases and squamous cell carcinoma making up about 20%.¹ Approximately 1% of all skin cancers are melanoma,² but melanoma causes higher skin cancer mortality compared with keratinocyte carcinoma.³ The degree to which skin cancer has spread before being detected is highly prognostic of survival.^4-6