Family History of Cancer

The study of genealogy has become fashionable! This knowledge may raise concerns about how one’s heritage impacts upon cancer risk. This has become of particular importance when considering the plethora of scientific advances in the clinical and molecular genetics of hereditary cancer that have piqued the interest of physicians as well as the laity. Identification of familial susceptibility to cancer requires compiling a family history of cancer of all anatomic sites. The compilation should include the age of cancer onset, the pattern of multiple primary cancers (including bilaterality of paired organs), extension of this information through the patient’s second-degree relatives whenever possible, and (when applicable) exposures to carcinogenic agents. This detailed cancer family history, particularly when documented by medical and pathology records, may be the most cost-beneficial component of the patient’s medical workup. Its cancer control potential should then be made available to all members of the extended family. However, our experience indicates that clinicians generally do not compile a family history of cancer in sufficient detail to diagnose a hereditary cancer syndrome and, if they do, primary and secondary at-risk relatives rarely benefit from this knowledge. This omission was documented when Lynch et aZ.,’ for the purpose of eliciting cancer family history and assessing its accuracy in existing medical records, interviewed 200 consecutive cancer patients who were undergoing treatment in an oncology clinic. Among these cases, they noted numerous examples of familial cancer clusters as well as hereditary cancer syndromes. However, in the overwhelming majority of cases, the family history of cancer, as reported in the patients’ initial medical records, had been either entirely omitted or reported as negative, despite substantial evidence to the contrary. Furthermore, even when the family history was strongly positive, the information was not utilized to benefit either the patient or his or her close relatives. Recently, David and Steiner-Grossman’ conducted a survey of 76 acute-care, nonpsychiatric hospitals in New York City to determine the notation of family history of cancer in the medical charts. Only 4 of the 64 reporting hospitals reported any notation of cancer family history. Surprisingly, the American College of Surgeons and accrediting agencies of hospitals did not require this information. The lack of family history compilation and recognition of hereditary cancer syndromes was recognized by Arvanitis et aL3 when they reported that 59% of patients with familial adenomatous polyposis (FAP) were dying of metastatic colorectal cancer despite its striking premonitory cancer phenotype. Specifically, the myriad adenomatous colonic polyps are readily accessible to clinical diagnosis through a proctoscope or