Your Medical Destiny

Mining your family’s past information can help safeguard your future health.

You’re sitting in a new doctor’s office, bending over a clipboard. On it is a list of ailments and conditions, from atrial fibrillation to yellow fever. “Does anyone in your family have a history of——?” the form asks. It’s tedious to fill out, and perhaps frustrating (what if you simply don’t know if your grandfather had anemia?), but it’s also a vital tool for your health. That history can help provide a road map of your possible medical future, and the steps you need to take to keep yourself hale and hearty longer.

Certain genetic variations and mutations can increase your likelihood of developing particular diseases. Says Michelle Graziano, M.D., a Cliffside Park internist affiliated with Englewood Health: “Knowing one’s family medical history helps shed light on our own potential health risks.” Essentially, it provides insight into your genetic risk factors, insight that can help your primary care doctor determine the level of care and monitoring you need. “This may change your habits or recommended screenings or inform potential treatment options,” the doctor says. “Knowing your specific history allows you to be proactive about the conditions most likely to affect you.”

Which medical conditions should raise red flags if you see them in your family tree? Dr. Graziano singles out four:

• Breast cancer. Apart from skin cancers, this is the most common cancer in women in the U.S. If your mother or grandmothers had it, pay special attention. “Breast cancer is one cancer we know has a hereditary component,” says Dr. Graziano. Mutations or variants in the two “breast cancer” genes, BRCA1 and BRCA2, are inherited from your parents and increase your risk of developing the illness. Doctors look for a history of breast cancer in first-degree relatives (parents, siblings or children) and second-degree relatives (aunts, uncles, grandparents and half-siblings) and consider these relatives’ age of diagnosis to estimate lifetime risk. “For those with a family history of these cancers, screening sooner or more frequently is worth exploring,” the doctor adds. Current guidelines suggest that breast-cancer screenings should begin no later than age 40 but, for high-risk individuals with a strong family history, recommended screening age drops down to 30.

• Colorectal cancer. Another cancer with a hereditary component? “Colorectal,” says our doctor. This disease can be caused by an inherited gene mutation, specifically in genes that help keep cell growth in check (such as the APC, or adenomatous polyposis coli gene) or repair DNA (for example, four genes known as MLH1, MSH2, MSH6 and PMS2). The term “Lynch syndrome” now describes what was formerly known as hereditary non-polyposis colorectal cancer: a defect in one of these cell-repairing genes that makes a malignancy more likely.

It’s recommended that routine screenings for colorectal cancer start at 45 for most patients but, if you have a strong family history of the disease and particularly if you have a first-degree relative who has been diagnosed, scanning should either start at age 40 or 10 years prior to the age of earliest diagnosis in their family, whichever comes first. Dr. Graziano says, “There are several genetic tests that can help identify individuals who may be at higher risk of specific cancers, which can guide monitoring and treatment options.” A cluster of cancer in the family is an indication that you should consider working with a genetic counselor, who can suggest testing for gene mutations. The tests can screen for mutated BRCA genes in addition to APC genes, Lynch syndrome and other common mutations that can increase your risk of colorectal cancer.

• Cardiovascular diseases. According to Dr. Graziano, “High blood pressure, high cholesterol, heart attack or stroke, particularly at a young age” are all conditions that can run in families. Cardiovascular disease (CVD) is the leading cause of death in both the country and the world, and someone dies of it every 34 seconds, according to the Centers for Disease Control and Prevention. Family history is a risk factor independent of lifestyle factors that put you at risk, such as obesity and smoking. Your risk increases the more first-degree relatives are affected, and knowing that can help you mitigate your lifestyle risks. “Not surprisingly, maintaining healthy habits is key to reducing the risk of heart disease,” says Dr. Graziano. “Limit salt and refined sugars in your diet and stay active.” Someone with a high enough genetic risk may also be advised to take further steps—to abstain completely from alcohol, for instance, and/or to go on prescription anticoagulants to help prevent blood clots.

• Type 2 diabetes. Dr. Graziano also flags diabetes as a condition with a genetic risk factor. There’s a stronger hereditary component to type 2 diabetes than type 1, particularly if a parent or sibling is also diagnosed, though it’s multifaceted. In the words of the American Diabetes Association, “You inherit a predisposition to the disease, then something in your environment triggers it.” As with CVD, a genetic predisposition to the disease can combine with lifestyle factors such as obesity or physical inactivity to increase one’s risk of developing it. If you have a sibling or parent who has been diagnosed, regular office visits and routine lab monitoring are recommended to identify prediabetes as early as possible, and discuss possible lifestyle changes and treatment options with your doctor. A healthy diet, exercise and weight management once again factor in, though there are also medications that can help bring blood sugar to the proper levels.

Sometimes talking about family medical history can be uncomfortable. Maybe your father feels ashamed of being prediabetic and doesn’t want to discuss it with his kids, or talking about her ovarian cancer is traumatic for your mother. “If reluctant family members realize that their personal stories and experiences can influence the health of a loved one, they are more likely to open up,” says Dr. Graziano. “Sharing your concerns or your own history can often help family feel comfortable sharing theirs.” She concludes: “Framing the importance of family history as a way to prevent future hardships—especially for younger family members—can be very persuasive.”