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Best In Science

Assessing Family History for Disease Risk and Prevention

Most disease results from a combination of genetic and environmental factors. Family members share genes, behaviors, lifestyles, and environments, which may make them more susceptible to certain chronic diseases. People who have close family members with a chronic disease—such as cancer, coronary heart disease, or diabetes—may have a higher risk of developing that disease.

As part of its family history initiative, CDC’s National Office of Public Health Genomics sponsored the creation of Family Healthware™. This tool is designed for individuals to collect and display their family history information. Individuals are asked to input information on six diseases (coronary heart disease, stroke, diabetes, and three cancers: colorectal, breast, ovarian) and specific behaviors, such as physical activity, diet, smoking, alcohol use, aspirin use, and the use of screening tests. In return, individuals receive a familial risk assessment (weak, moderate, strong) for each disease along with prevention messages tailored according to their risk. These messages encourage the adoption or maintenance of healthy lifestyles and early detection behaviors, such as scheduling regular screening tests.

A CDC-sponsored evaluation study of the clinical utility of Family Healthware™ was completed in 2007. About 3,600 participants and about 190 clinicians from 13 states participated in the study. Approximately 82% of the participants showed a moderate to high familial risk for at least one of the six diseases included in the tool.

Awareness and Behavior Change

• Most participants were aware of their familial risk and were also accurate in evaluating their risk level. However, participants in the high-risk category tended to underestimate their familial risk.
• Participants who were aware of their elevated familial risk for specific diseases were not more likely to undertake screening tests for the diseases involved.
• Participants who were informed of their familial risk and advised to take measures according to their risk were more likely to talk to their primary care physician about this risk at their next appointment. They were also more likely to collect additional family history information from their relatives.

This study showed that among people with access to primary health care and preventive services, it is possible to induce some positive changes using family history information. Family history could be an essential component of public health prevention strategies for diabetes, coronary heart disease, and cancer; family history can also help identify groups at risk for these diseases. It could also help health providers make decisions about screening and early testing for some diseases, which can lead to early disease detection among those at risk.

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