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.