SAN FRANCISCO--A thorough and accurate family history, going back at
least four generations, is one of the most effective tools for
establishing genetic cancer risk in a patient, Andrea Fishbach, MS,
MPH, of Kaiser Permanente, San Francisco, said at the American Cancer
Societys 2nd National Conference on Cancer Genetics. But
counselors should be aware that taking such a history can release
strong emotions in the patient.
A family history, she said, can reveal much about family dynamics,
showing the social relationships within the family and how
information flows. "Behind these symbols in the family tree are
people and relationships," she said. "You have to remember
that during the family history gathering." She recalled one
patient who burst into tears after seeing on a chart all the members
of her family who had died of cancer. "She had never grieved for
them collectively," Ms. Fishbach said.
Other emotional issues may come up during a family history. Patients
may be fearful of having a genetic disease, afraid of the social
stigma of carrying a cancer gene, or wary of having to make a
decision about genetic testing.
It is vital to verify the facts in the history through pathology
reports, hospital records, and histologic sections, if available, Ms.
Fishbach said, especially concerning the patients remote
relatives. A 1985 study by Love, for example, found that patients
often could name the primary site of their primary relatives
cancer, but cancer in remote relatives was significantly underreported.
Is Grief Counseling Necessary?
As the patient and clinician delve into the family history, the
clinician can identify if genetic counseling is needed and also
should consider if grief counseling would be useful. "Often
there is grief and guilt about being part of a family with a cancer
gene. We want to instill hope with counseling, reinforce coping
methods, and teach new ways of coping," Ms. Fishbach said.
Another goal of counseling, she said, is to promote family
communication so that each member can make accurate decisions about
his or her risk.