Frequency and face validity of reported family history of cancer in first-degree relatives and genetic syndromes among children with cancer in Project:EveryChild: A report from the Children’s Oncology Group

Background: Taking a family history of cancer (FH) is essential for identifying individuals with heritable cancer predisposition. Project:EveryChild (Children's Oncology Group [COG] trial APEC14B1), the registration and biobanking protocol of the COG, includes suggested questions about FH in first-degree relatives and personal history of genetic syndromes (GS) in pediatric oncology patients. The validity of these items is unclear; therefore, the authors assessed the data quality and face validity of the responses. Methods: The authors analyzed case report forms regarding FH and GS of 30,157 participants (aged birth to 21 years) with newly diagnosed pediatric cancer enrolled in APEC14B1. FH and GS data were manually curated to interpret the responses and group them into categories, followed by face validity assessment—defined as the extent to which the information provided represented what it was intended to capture. Results: Responses were provided for 65.7% of participants (n = 19,810), with 6.1% reporting FH (n = 1204). Of those, 97.9% (n = 1178) included sufficient free-text detail to assess face validity, although 49.4% required manual interpretation. Among FH reports, 48.3% (n = 595) were suggestive of heritable cancer risk. GS was reported in 4.3% of responders (n = 863), with 93.3% (n = 780) showing face validity after curation. Down syndrome (n = 302) and neurofibromatosis type 1 (n = 93) were the most frequently reported syndromes, with neurofibromatosis type 1 most common in patients who had central nervous system tumors. Conclusions: Despite limitations and the need for manual curation, FH and GS data collected by using proposed questions were sufficient to identify known heritable cancer patterns. These findings support questionnaire-based data collection and highlight areas for improvement.