This holiday season, many of us would probably like to avoid discussing politics at family gatherings. So here’s an idea: Talk family health history instead.
Since many health problems run in families, a holiday gathering is a good time to delve into a discussion about the health of your blood relatives, both living and deceased. This exercise can offer a glimpse of any conditions or illnesses to which you and your family may be predisposed, such as heart disease, high blood pressure, diabetes, stroke, certain cancers (including breast, ovarian, and colorectal), osteoporosis, and asthma.
Having a family history of a disease doesn’t mean you’ll also develop the same condition. But, since some diseases do run in families, you can share your genetic background with your doctor, who canadvise you of any measures that could prevent or decrease the risk of a particular disease or detect it at an early stage when therapy is likely to be most effective.
What to include and where to find it
A detailed and accurate family history is one of the most fundamental tools used in medicine. Ideally, it should cover the health history of as many first-degree relatives (parents, siblings, and children) and second-degree relatives (grandparents, grandchildren, aunts, uncles, nieces, nephews, and half-siblings) as possible. A useful tracking tool is the Surgeon General's online Family Health Portrait, which is easy to use and helps you create a drawing of your family tree and a chart. If you prefer not to complete the information online, you can print a PDF version to fill out by hand at My Family Health Portrait Tool.
However you choose to compile your family's history, include all available information about any major illness, chronic disease, mental disorder, or substance abuse problem each relative has had and—when possible—the age at which each disease was diagnosed, the age when each relative died, and the cause of death. Useful sources of information in addition to family members include personal health records, medical records from doctors’ offices and hospitals, and birth or death certificates, usually available from the vital records office of the state in which the birth or death occurred.
If you were adopted, you can try to find out whether your parents received any medical information about your biological parents from the adoption agency. If you know the adoption agency, you might be able to request to see any medical information it may have on file. Once you’ve compiled your information, look for patterns that may point to a predisposition for certain diseases in your family.
Items to flag include:
- A relative who died of an illness at an early age
- A relative who developed an illness at an early age
- Several relatives who developed the same condition
- More than one type of cancer in the same relative
- The occurrence of the same disease in more than one generation
- Certain combinations of diseases (breast and ovarian cancer, for example)
- A disease that’s uncommon in a certain gender (such as breast cancer in a male)
Once you’ve completed a health profile of your relatives, share it with your doctor. If your doctor thinks you might be at increased risk for a particular disease, he or she can recommend appropriate preventive measures, which might include genetic or other testing, more frequent screenings (such as mammography or colonoscopy), changes in diet, increased activity, and weight loss.
Is genetic testing in your future?
If your family history indicates an unusually high risk of a particular condition, your doctor may suggest considering genetic testing. For example, women and men with a strong family history of breast, ovarian, or colorectal cancer (especially if the cancer occurred at a young age) should consider genetic testing. BRCA1 and BRCA2 are the best-known cancer genes. And though BRCA stands for Breast CAncer, such mutations also increase the risk of ovarian, prostate, and other cancers.
If you decide to pursue genetic testing, your doctor may refer you to a genetic counselor to review your family history and determine whether testing is appropriate for you and other family members. Genetic counselors can help you understand complex genetic information as well as help you make informed decisions.
Planting your family tree
Genes are only part of the story. What we do (and don’t do) interacts with what we have inherited. The big killers—notably coronary artery disease, strokes, most cancers, and diabetes—are multifactorial.That is, genes interact with environmental and lifestyle factors, like diet and smoking, to determine whether you will develop certain diseases and when.
If such multifactorial disorders run in your family, you merely have an inherited tendency to develop them. In other words, the disorders may never manifest themselves, depending in large part on lifestyle choices you make and environmental factors.
This article first appeared in the November 2018 issue of UC Berkeley Health After 50.
Also see Family History 101.