Family Health History: Use It to Inform Preventive Services for Your Patients
Family Health History
Hello. I am Dr. Katherine Kolor from the Office of Public Health Genomics at the Centers for Disease Control and Prevention. I am speaking to you as part of the CDC Expert Commentary Series on Medscape about the importance of collecting family health history information in your practice. I will use recommendations from the US Preventive Services Task Force (USPSTF) to illustrate how this information can inform preventive services for your patients.
The collection of family health history is routine in many healthcare settings. Family health history is a risk factor for a variety of chronic conditions for which effective screening and prevention tools are available. The USPSTF considers family health history in more than 20 of its current recommendations (Appendix), and family health history can affect the recommended practices of several USPSTF recommendations, including screening for lipid disorders in adults, colorectal cancer screening, andgenetic evaluation for BRCA-associated hereditary breast and ovarian cancer. I will use these 3 USPSTF recommendations as case studies to demonstrate the utility of family health history information in practice and to illustrate the components of an informative family health history.
Screening for Lipid Disorders in Adults
Lipid disorders are acquired or familial abnormalities of lipoprotein metabolism and include elevations of total cholesterol, LDL cholesterol, triglycerides, or deficiencies of HDL cholesterol. The USPSTF strongly recommends screening men aged 35 and older for lipid disorders, and recommends screening men aged 20-35 for lipid disorders if they are at increased risk for coronary heart disease. The USPSTFstrongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease, and recommends screening women aged 20-45 for lipid disorders if they are at increased risk for coronary heart disease. A family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives is one of several factors that are sufficient to define increased risk for coronary heart disease. Although the specific relatives of interest are not defined in the recommendation, collecting information about cardiovascular disease in a patient's parents, grandparents and other first- and second-degree relatives, including age of onset, can be an important consideration when determining at what age screening for lipid disorders is recommended.
Colorectal Cancer Screening
The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The recommendations specifically exclude those with the inherited syndromes (Lynch syndrome or familial adenomatous polyposis) but otherwise, the recommendations "do apply to those with first-degree relatives who have had colorectal adenomas or cancer." The recommendations state that for "those with first-degree relatives who developed cancer at a younger age or those with multiple affected first-degree relatives, an earlier start to screening may be reasonable." Although what constitutes a "younger age" and an "earlier start to screening" is not specified, your decision-making about colorectal cancer screening for your patient could be informed by collecting information on colorectal cancer for all first-degree relatives for whom the information is available, including age of onset.
Genetic Evaluation for BRCA-Associated Hereditary Breast and Ovarian Cancer
The USPSTF recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation forBRCA testing to inform risk-reducing interventions. Noting that there currently are no standardized referral criteria, the USPSTF listed specific family history patterns associated with increased risk, including, but not limited to: