Most clinic records answer the question badly. Family history of colorectal cancer is captured as present or absent, sometimes with a relative named, rarely with an age, and almost never with a count. That record cannot be used to make a surveillance decision, so the decision defaults to the patient's own disease.
The history worth taking is short. Ask how many first-degree relatives, meaning parents, siblings and children, have had colorectal cancer, and how old each was at diagnosis. Then ask the same about second-degree relatives, and about endometrial, ovarian, gastric, small bowel and urinary tract cancers, which is what turns a vague family history into a possible Lynch syndrome referral.
Write the count and the ages in the record as numbers. One relative diagnosed at 68 and two relatives diagnosed in their fifties lead to different plans, and neither is recoverable from the phrase positive family history. This takes about ninety seconds and it is the single piece of information most likely to change a surveillance interval.
- Record the number of affected first-degree relatives and each age at diagnosis, as numbers
- Ask about second-degree relatives too before concluding the family history is negative
- Ask about endometrial, ovarian, gastric, small bowel and urinary tract cancers when considering Lynch syndrome
- Update the family history at review appointments; it changes and the original entry rarely does
- Note that many patients do not know: record uncertainty explicitly rather than as absence
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