Integration of family history and medical management of patients with hereditary cancers.

Abstract

The family histories of individuals affected by a wide variety of cancers have provided information about the principal features of hereditary cancer. Surveillance protocols, indicating the most appropriate modalities and the age at which to initiate them, have been derived from what has been learned about the age of onset and the cancer sites associated with specific cancer syndromes. Likewise, cancer management has been based on what is known of the natural history of the syndrome cancers from studying multiple affected families. Family history has even been an essential tool for molecular geneticists as they have mapped and eventually identified genes for such cancer syndromes as hereditary breast ovarian carcinoma (HBOC), familial adenomatous polyposis (FAP), and hereditary nonpolyposis colon carcinoma (HNPCC). Despite the rapid integration of molecular genetics into the diagnosis and management of individuals at high risk for hereditary cancer, family history remains an essential tool in all aspects of cancer genetic health services. Recognition of a hereditary cancer syndrome through a family's history offers a primary care provider an opportunity to intervene on behalf of not just one patient but an entire family. Once hereditary cancer is identified, the information that has been learned and the protocols developed from numerous family histories can be applied to one individual or family based on their specific family history.