Oncologists seeing a new patient with cancer should take a family history, specifically asking about cancers in first- and second-degree relatives.
This is the conclusion of a panel of 15 experts, led Karen Lu, MD from the University of Texas M.D. Anderson Cancer Center in Houston (USA). About 5% to 10% of all cancers are attributable to a hereitary cancer predisposition sundrome. These include hereditary breast and ovarian cancers linked to BRCA1/2 (and other) mutations, and also Lynch syndrome (which increases the risk for colorectal and several other cancers).
For patients, such information can impact their cancer management (for example, a BRCA (breast cancer gene) carrier may opt to take out both ovaries and both breasts). For relatives, such knowledge can lead to predictive genetic testing and more precise risk management with screening or risk reduction strategies.
What You Need to Do (If You Have Cancer)
- If possible,trace your history back 2 to 3 generations. Medical geneticists often prefer 3, but some accuracy is lost as we move away from 1st or 2nd)
- Ask yourself if there is any history or cancer in first degree relatives (parents, children, full siblings) and in second-degree relatives (grandparents, aunts/uncles, nices/nephews, grandchildren, and half-siblings)
- “Red flags” for heretiary cancer predisposition include early age of onset of cancer, multiple affected relatives with cancer on the same side of the family
- For each relative with a history of acner, record details such as age at diagnosis and type of primary cancer(s), lineage (maternal or paternal), ethnicity, and results of any cancer genetic testing in any relative.
- Recognize that ongoing hereditary risk assessment is important (family histories change).
My Take: An adequate family history is a key to identifying those patients whose cancer may be associated with inherited genetic factors. It can also help us to optimize management for an individual patient (and, in some cases, family members). We can do better: A February 3, 2014 study in the Journal of Clinical Oncology indicates that a complete family history was documented in less than 40% of patients. Referral for genetic counseling occurred in 22% of all patients. However, less than half (43%) of those who were likely to have a hereditary form of cancer were referred. Finally, We do a better job with patients with breast cancer compared to other cancers (such as colon cancer). I’m Dr. Michael Hunter.
The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.
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- J Clin Oncology. Lu K, et al. Published online February 3, 2014 as 10.1200/JCO.2013.50.9257
- J Clin Oncology. Wood ME, et al. Published online February 3, 2014 as 10.1200/JC).2013.51.4661