Screening for lipid disorders in adults 10 Women at increased risk for breast cancer (e.g., those with a family history of breast cancer in a mother or sister, a previous breast biopsy revealing atypical hyperplasia, first childbirth after age 30) are more likely to benefit from regular mammography than women at lower risk. Perform screening mammography, with or without clinical breast examination, every one to two years in women 40 years of age and older. A first-degree family history of abdominal aortic aneurysm that required surgical repair also increases menвЂ™s risk. Major risk factors include age (65 years or older), male sex, and a history of smoking (at least 100 cigarettes in a personвЂ™s lifetime). Perform one-time ultrasound screening in men 65 to 75 years of age who have ever smoked. Screening for abdominal aortic aneurysm 8 Older age, a family history of breast cancer, and a history of atypical hyperplasia on breast biopsy are the strongest risk factors for breast cancer. Initiating screening at an earlier age is reasonable in persons at higher risk (e.g., those with a first-degree relative who receives a diagnosis before 60 years of age).Д®xpert guidelines exist for screening very high-risk patients, including those with a history suggestive of familial polyposis or hereditary nonpolyposis colorectal cancer.Д«ehavioral counseling in primary care to promote a healthy diet 6Д¬ounsel adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease.Дiscuss chemoprevention with women at high risk for breast cancer and at low risk for adverse effects of chemoprevention. Screen men and women 50 years and older for colorectal cancer. Risk assessment should include questions about age, sex, diabetes, elevated total cholesterol levels, low high-density lipoprotein cholesterol levels, elevated blood pressure, family history, and smoking. TABLE 1 USPSTF Recommendations Based on Family History LevelДЄspirin for primary prevention of cardiovascularevents 4Дiscuss aspirin chemoprevention with adults who are at increased risk of coronary heart disease. Alternatively, when a relatively common disease is caused by an inherited mutation in a single gene, family history assessment may lead to early diagnosis and more aggressive management ( Table 3).

Family history assessment also can help identify relatively rare conditions that may not be considered in a differential diagnosis ( Table 2). Preventive Services Task Force involve a consideration of relevant family history ( Table 1 4 вЂ“ 13В ). Clinical preventive measures for asymptomatic patients recommended by the U.S. Assessment of family history is useful to detect increased risks for diseases that have modifiable risk factors or preventable exposures. Inherited variations within these genes confer individual risks that can differ greatly from the population-based average. 1 вЂ“ 3 Most common diseases result from a combination of environmental factors and variations in multiple genes. However, the utility of family history in the assessment of risk for common diseases is becoming increasingly recognized. Major organizations have endorsed using standardized symbols in pedigrees to identify inherited contributions to disease.ДЄ three-generation pedigree has been used for diagnostic consideration or risk assessment of rare single-gene or chromosomal disorders. The family history is useful in stratifying a patientвЂ™s risk for rare single-gene disorders and more common diseases with multiple genetic and environmental contributions. Two recent events have made family history assessment more important than ever: the completion of the Human Genome Project with resultant identification of the inherited causes of many diseases, and the establishment of national clinical practice guidelines based on systematic reviews of preventive interventions. The three-generation pedigree provides a pictorial representation of diseases within a family and is the most efficient way to assess hereditary influences on disease. The collection of a family history ranges from simply asking patients if family members have the same presenting illness to diagramming complex medical and psychosocial relationships as part of a family genogram.

Genogram example 3 generations