Genealogy Research and Higher Odds of Family Health History Confidence: A Cross-Sectional Study of US Adults Affected by Cancer

Family health history (FHH) is an important tool for cancer risk assessment, yet its clinical utility is undermined by incomplete data, particularly among historically marginalized communities whose family records have been systematically disrupted by slavery, forced displacement, and undocumented status. I conducted a cross-sectional online survey of 1885 US adults affected by cancer to examine associations between genealogy engagement and FHH confidence and to assess variation across sociodemographic subgroups. Genealogy research was the single strongest modifiable predictor of FHH confidence, with participants reporting genealogy research more than twice as likely to report high confidence compared to those who did not (OR = 2.07, 95% CI 1.72–2.50), a relationship that persisted after full adjustment for age, sex, race, income, and education. Despite comparable rates of genealogy engagement, Black and Hispanic respondents reported substantially lower FHH confidence than White respondents. These findings suggest that while interest in genealogy is already widespread and self-motivated in the population, current clinical tools for FHH collection are inadequate to leverage this interest equitably. Next-generation FHH tools should be designed to reflect the dynamic, collaborative features of genealogy platforms rather than static medical forms, and their development must be grounded in community-centered design principles that prioritize populations for whom incomplete family history poses an added burden.