To the Editor:
Family history has traditionally served as a raw predictor of disease risk in patients. Recently, more attention has been paid to defining the best approach to eliciting this history and how it might better guide disease prevention protocols. Frezzo et al. 1 and Scheuner 2 discuss the development of a self-administered family history questionnaire for patients that appears easy to use and informative. Scheuner 2 notes the “need for improvement in [family history documentation]” by primary care physicians and that this questionnaire appears a viable substitute for the time-consuming three-generation pedigrees physicians might otherwise construct. She continues that the introduction of such clinical tools, if proven valid, could revolutionize preventive medicine and “lead to the development of a public health campaign… Know your family history: It could save your life.”2
Though a noble vision, the ability to save lives based on family history information will require more than just empowering patients with knowledge of heritable diseases and providing physicians with risk-based algorithms for management. As we continue to learn about genetic influences on common diseases and, ideally, identify disease-associated gene loci, achieving improved disease prevention in general will demand a fundamental paradigm shift in medical practice—from a “reactive, disease-oriented medical culture toward a proactive, health-based one.”3
The public health community has already taken steps to achieve this. The Agency for Health Care Policy and Research spearheaded the “Putting Prevention into Practice Program” (PPIP) because there are “too many gaps between the prevention knowledge and tools that scientific advances have given us and the preventive care” patients receive. 3 PPIP offers materials that enable clinicians to comply with recommended prevention guidelines and publishes handbooks encouraging patients to take an active role in disease prevention. These materials include an annual adult health risk profile for patients, containing direct questions about family history of hypertension, cardiovascular disease, hyperlipidemia, gastrointestinal and gynecological cancers, and glaucoma. 4
Considering the efforts that have already gone into programs such as PPIP, approaches to achieving better genetic risk prediction and disease prevention, whether through self-administered family history questionnaires or direct genetic testing, might best be integrated into established prevention initiatives.
References
Frezzo TM, Rubinstein WS, Dunham D, Ormond KE . The genetic family history as a risk assessment tool in internal medicine. Genet Med 2003. 5: 84–91.
Scheuner MT . Family history: Where to go from here. Genet Med 2003. 5: 66–68.
Reynolds T Putting prevention into practice: The physician's role. Ann Intern Med 1998. 129: 679–680. Available at www.acponline.org/journals/annals/pastiss/15oct98.htm. Accessed April 26, 2003.
Putting Prevention Into Practice. Adult Health Risk Profile (text version). Available at: http://www.ahcpr.gov/ppip/manual/profadul.htm. Accessed April 26 2003.
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Mikail, C. Genetics and preventive medicine: Beyond family history. Genet Med 5, 407 (2003). https://doi.org/10.1097/01.GIM.0000087501.88142.58
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DOI: https://doi.org/10.1097/01.GIM.0000087501.88142.58