Cancer risk assessment from family history: gaps in primary care practice.
OBJECTIVE
To determine whether an adequate amount of family history is being collected and recorded by family practitioners to appropriately identify patients at increased risk for cancer.


METHODS
Retrospective chart audit.


METHODS
Charts from 500 randomly chosen patients, 40 to 60 years of age, were audited. Of those charts, 400 were from a large academic family practice and 50 charts each were from 2 small community family practices in the greater Philadelphia area.


METHODS
General features of family history taking were recorded, including presence of a family history and date when recorded, evidence of updated family history data, and presence of a genogram. Cancer features recorded included mention of family history of cancer or colon polyps and, if positive, identification of which relative was affected, site of cancer, and age of diagnosis or death.


RESULTS
Most charts (89%) had some family history information recorded, and 55% listed a family history of cancer, either positive or negative. Of the 356 relatives affected with cancer, an age of diagnosis was documented in only 8%; of 183 first-degree relatives with cancer, only 7% had a documented age of diagnosis. Two percent of all charts had any mention of a family history of colon polyps. Sixty-five percent of family histories were recorded at the first visit, and only 35% had any updated family history information.


CONCLUSIONS
The number and type of family histories currently being recorded by family practitioners are not adequate to fully assess familial risk of cancer. New strategies will need to be developed to better prepare providers for risk-based clinical decision making.
Sifri
Randa D
RD
Department of Family Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA. randa.sifri@mail.tju.edu
Wender
Richard
R
Paynter
Nina
N
D000328:Adult; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening; D008485:Medical Audit; D008487:Medical History Taking / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods