Comparability of surrogate and self-reported information on melanoma risk factors

Surrogate reports by patients about their relatives, and vice versa, are potentially of great use in studies of the genetic and environmental causes of the familial aggregation of cancer. To assess the quality of such information in a family study of melanoma aetiology in Queensland, Australia, the authors compared surrogate reports with self-reports of standard melanoma risk factors obtained by mailed self-administered questionnaire. There was moderate agreement between surrogate reports provided by the cases and relatives' self-reports for questions on ability to tan (polychoric correlation coefficient (pc) = 0.60), skin colour (pc = 0.57), average propensity to burn (pc = 0.56), and hair colour at age 21 (kappa coefficient = 0.55), although relatives in the extreme risk factor categories were misclassified by surrogates at least half of the time. Agreement was lower for questions on degree of moliness (pc = 0.45), tendency to acute sunburn (pc = 0.42), and number of episodes of painful sunburn (pc = 0.23). The quality of relatives' surrogate reports about cases was similar to that of cases' surrogate reports about relatives. Cases who reported a family history of melanoma provided better surrogate information than did cases who indicated no family history, and female cases provided better surrogate reports than did males. Cases were better able to report for their parents and children than for their siblings. The authors conclude that when the use of surrogate reports of melanoma risk factors is unavoidable, results should be interpreted cautiously in the light of potentially high rates of misclassification. In particular, surrogate reports appear to be a comparatively poor measure of self-assessment of number of moles, the strongest known phenotypic indicator of melanoma risk, and may bias comparisons between families with and without a history of melanoma.