Family History of Cancer/Genetic Counseling Often Lacking for Patients First Presenting with Malignancy

August 2012 Vol 5, No 5, Special Issue ASCO 2012 Payers' Perspective
Wayne Kuznar

Chicago, IL—A family history of cancer is not always documented by primary care or specialty practices, even though the identification of family cancer history is an integral feature of high-risk screening guidelines, according to data from a pilot project.

“Family history is important not only for the identification of individuals without cancer who have a strong family history and can be candidates for accelerated screening and intervention, but [also in] individuals who have cancer, [and in] those who have a family history and are at increased risk for second primary cancer,” said Marie Wood, MD, Director of the Familial Cancer Program, and Deputy Director of Hematology/Oncology, University of Vermont, Burlington, at ASCO 2012.

Data were taken from 213 practices that were pilot tested for the implementation of ASCO’s Quality Onco­logy Practice Initiative, designed to assess family history taking and genetic counseling/genetic testing (GC/GT) referral. Researchers assessed the presence of cancer family history in first- and second-degree relatives, the patient’s age at diagnosis, referral for GC/GT, and referral outcomes.

Data were available for 10,466 patients—6569 with breast cancer and 3897 with colorectal cancer; 77.4% of their charts had documented cancer family history in first-degree relatives, and 61.5% contained documentation in second-degree relatives. History taking of cancer in first-degree relatives was done in more patients with breast cancer than those with colon cancer, as well as in second-degree relatives. The age at time of cancer diagnosis in relatives, however, was documented in only 30.7% of all charts.

In 22.1% of reviewed charts, the patients were referred for GC/GT. A greater number of patients with—than those without—a positive family history of cancer were referred for GC/GT, but this number reached only 42.7%. Referrals were greater in patients with breast cancer than those with colorectal cancer (29.1% vs 19.6%, respectively). Similarly, in patients with a hereditary risk for cancer—defined by selected risk guidelines—52.2% of those with breast cancer and 26.4% with colorectal cancer were referred for GC/GT.

“We were glad to find high rates of first-degree family documentation for all breast and colon cancer patients. However, there were very low rates of documentation of the age of an individual at cancer diagnosis,” said Dr Wood. “Referral rates must be higher, because this impacts cancer care.” n

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Last modified: August 30, 2012
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