ASCO Recommendations on Family History a ‘Good First Step’

Before any patient begins treatment for cancer, oncologists should discuss first- and second-degree family cancer history, according to new recommendations from the American Society of Clinical Oncology (ASCO). The ASCO recommendations, published recently, are the first to focus on family history and a person’s genetic risk of cancer.

Huma Rana, MD, counsels patients on their genetic history and cancer risk.
Huma Rana, MD, counsels patients on genetics, family history and cancer risk.

“Genetic makeup is critical in the management of patients and treatment of cancer,” says Huma Rana, MD, a cancer geneticist with Dana-Farber’s Cancer Genetics and Prevention Program. “It also has implications for other family members and their potential risk.”

Approximately 5 to 10 percent of all cancers are inherited, Rana says. Evaluating patterns of cancer in a family may help doctors determine whether a patient has a predisposition to hereditary cancer and if he/she needs further genetic testing or counseling. Doctors can also use genetic results to help tailor treatments or survivorship plans.

First-degree relatives include parents, siblings, or children; second-degree relatives include grandparents, aunts/uncles, nieces/nephews, grandchildren and half-siblings. ASCO says doctors should focus on the family members’ type of primary cancers, the age of diagnosis, lineage (maternal/paternal), ethnicity, and results of genetic tests that have been done on other relatives.

Although Rana sees the recommendations as a good first step, she says it is also important for doctors and patients to discuss any rare cancers or cancer patterns in the family, even if they are in third-degree relatives, such as cousins or great-grandparents.

“At the very least, doctors should gather details on first- and second-degree relatives,” Rana says. “But there are many situations beyond first- and second-degree relatives where patterns of cancer can provide important information.” 

For more information on genetic counseling and testing, visit Dana-Farber’s Cancer Genetics and Prevention Program website. If you have specific questions about hereditary cancers or genetic testing, the Dana-Farber cancer genetics team is available to answer your questions.