If you are interested in cancer prevention, you may know that for common cancers family history is one of the most important and useful tools that we have to identify people at elevated risk (who are likely to benefit most from more intensive screening and/or preventative measures).
Despite this fact, discussion of family history often gets lost in the shuffle in primary care - which is not surprising given how much stuff today's healthcare providers need to pack into a visit that often may only last 10 minutes or so. That said, many healthcare providers are doing a better job of asking about a family history of cancer, but it is usually a static, one-time assessment that may happen most at the time of initiation of primary care with a new doctor.
A newly published research article by Argyrios Ziogas, Nora Horick, Sharon Plon, Dianne Finkelstein and colleagues from the Cancer Genetics Network (CGN) in JAMA provides evidence and analysis that suggests that doctors and patients should also pay more attention to changes in family history of cancer over time.
Ziogas and colleagues used a couple of different analytical approaches to try to find answers to this question:
How often do family cancer histories change enough over time that they would merit changes in the intensity of screening based on American Cancer Society guidelines?
They focused on 3 of the most common cancer types: breast cancer, colorectal cancer, and prostate cancer. Although there are a few caveats, in general, their results suggest that it is well worth it for people to make sure that their doctors are aware of any changes in their cancer history.
In the case of breast cancer, their results suggest that about 4 percent of women will have a change in their family history of cancer between the ages of 30 and 50 sufficient to suggest that they are in a somewhat higher risk group that may benefit from breast MRI screening (per American Cancer Society Guidelines).
For colorectal cancer, their results suggest that about 5 percent of people will have a change in their family history of cancer between ages 30 and 50 that suggests that a more aggressive colonoscopy screening strategy may be warranted (per American Cancer Society Guidelines).
The impact of prostate cancer family history changes was less impressive.
Overall, it seems clear that in the clinic we need to think of cancer family history as the often changing entity that it is, rather than the static, never changing, thing that may get entered in the clinic chart at the first visit and then never re-visited.
What You Can Do: If someone in your family is newly diagnosed with cancer (parents, brothers, sisters, children, aunts, uncles, grandparents, cousins), let your physicians and other healthcare providers know about it the next time you see them. This way, they can update the family history that they have on file for you and consider whether the information might suggest that you should have more intensive cancer screening.
Cited Reference
Ziogas A, Horick NK, Kinney AY, et al. Clinically relevant changes in family history of cancer over time. JAMA 2011; 306:172-8.
Further Reading
Acheson LS. Recording, interpreting, and updating the family history of cancer: implications for cancer prevention. JAMA 2011; 306:208-10.
Qureshi N, Wilson B, Santaguida P, et al. Collection and use of cancer family history in primary care: Evidence Report/Technology Assessment No. 159. Rockville, MD: Agency for Healthcare Research and Quality, 2007. AHRQ Publication 08-E001.
Scheuner MT, McNeel TS, Freedman AN. Population prevalence of familial cancer and common hereditary cancer syndromes: the 2005 California Health Interview Survey. Genet Med 2010; 12:726-35.
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