Researchers are now at work on a prototype computer-based survey that patients will complete in their homes or in their physicians' offices. The information they provide will be analyzed using built-in algorithms. Ultimately, a report will be generated summarizing a patient's level of risk for one or more specific diseases.

Working with a primary care physician, a patient could then be steered down a proper course of prevention or, if the risk level is particularly high, to a genetic counselor.

"Most of the time our genes and our environment are interacting to determine our risk," said Sharon Kardia, PhD, director of the University of Michigan's Public Health Genetics Program in Ann Arbor. "The public and health care professionals need to understand that we can alter our genetic risk by changing our environment." Dr. Kardia is a member of a CDC working group that is steering the initiative.

Designing the resource tools

A panel of experts that met last year and formed the working group determined that the prototype tool to collect the relevant data should include just six diseases at the start: heart disease, stroke, diabetes, breast cancer, ovarian cancer and colon cancer. Other diseases will be added as they are validated, said Dr. Yoon.

The group included diseases in which family history was an established risk factor, that carried a substantial public health burden, had a well-defined case definition and for which there was a high degree of recognition by relatives. They also chose diseases for which there were effective interventions as well as different interventions depending on the patient's level of risk, whether average, above average or much above average.

Physicians will receive an electronic resource manual -- one that will likely be downloadable to PDAs -- to help guide selection of appropriate screenings and interventions that will be adapted from existing guidelines and common medical practice.

Three research centers were recently awarded funds to put the prototype through its paces in a clinical trial which is likely to commence a year from now, Dr. Yoon predicted.

Louise Acheson, MD, associate professor in family medicine and oncology at Case Western Reserve University School of Medicine in Cleveland, is leading one of the three centers. "We have a team of researchers in the family medicine department and in the Center for Human Genetics who have been interested for five or six years in ways to make it easier for patients and clinicians to systematically use family histories for their medical care," she said.

The use of a standardized and computerized tool to collect data will streamline the process and vastly trim the amount of time required in face-to-face physician-patient time. "We know that the average length of time that a doctor and patient are face to face in family medicine is about 10 minutes," she said. "If you want to take a detailed three-generation family history, it would take about 30 minutes."

Dr. Acheson and colleagues at Case Western will be working with the American Academy of Family Physicians' National Network for Family Practice and Primary Care Research when testing the prototype in clinical situations.