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

The family histories of individuals affected by a wide variety of cancers h ave 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 learne d about the age of onset and the cancer sites associated with specific canc er syndromes. Likewise, cancer management has been based on what is known o f the natural history of the syndrome cancers from studying multiple affect ed families. Family history has even been an essential tool for molecular g eneticists as they have mapped and eventually identified genes for such can cer syndromes as hereditary breast ovarian carcinoma (HBOC), familial adeno matous polyposis (FAP), and hereditary nonpolyposis colon carcinoma (HNPCC) . Despite the rapid integration of molecular genetics into the diagnosis an d management of individuals at high risk for hereditary cancer, family hist ory remains an essential tool in all aspects of cancer genetic health servi ces. Recognition of a hereditary cancer syndrome through a family's history offers a primary care provider an opportunity to intervene on behalf of no t just one patient but an entire family. Once hereditary cancer is identifi ed, 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. Cancer 1999;86:2525-32, (C) 1999 American Cancer Society.