Family history remains one of the most accessible tools for preventive risk stratification, yet it is still underused, inconsistently documented, and often insufficiently interpreted in routine practice. This is especially relevant in colorectal cancer prevention, where family history can alter the recommended age of screening initiation, influence the preferred screening modality, and indicate the need for genetic counseling when hereditary cancer syndromes are suspected. Structured family-history taking should therefore be regarded not as a minor conversational task but as a core clinical competence. Colorectal cancer is a particularly suitable model condition because screening can prevent disease through the detection and removal of precursor lesions, and because missed familial risk may delay appropriate surveillance. The FARKOR program provides an important real-world example. In this Bavarian program for persons aged 25 to 50 years, simplified family history was documented in 25,847 individuals, 22.3% had a positive family history and among 1595 colonoscopies included in the main analysis, adenomas were detected in 17.6%, advanced adenomas in 5.9%, and carcinomas in 0.3%. At the same time, the program revealed inconsistencies between simplified and comprehensive family histories and difficulties in interpreting complex familial constellations. These findings support a broader conclusion: family-history taking must be structured, taught, and embedded in clinical workflow. Better training should focus on elicitation, interpretation, communication, and referral decisions. Strengthening this competence in colorectal cancer prevention may also improve preventive care in other chronic and hereditary conditions.

Keywords: Family history; Colorectal cancer; Screening; Prevention; Anamnesis; Hereditary risk; Primary care; Medical education

Abbreviations: CRC: Colorectal Cancer; CFH: Comprehensive Family History; SFH: Simplified Family History; iFOBT: Immunological Fecal Occult Blood Test