Tracking heredity: Family health history matters

It’s routine now for doctors to ask about family history of heart disease, diabetes and cancer. Do you really know the answers, or are you guessing?

Getting a more accurate map of family health patterns offers a physician more clues to your risk factors – perhaps setting a course to earlier screenings and preventive steps. Finding a risk or disease earlier often means better health in the long run.

The Centers for Disease Control and Prevention suggests taking time during upcoming holiday visits to ask relatives about certain health conditions that can run in families.

Record details and share them with other relatives along with your physician, the agency says. You also can use the Surgeon General’s web-based “My Family Health Portrait” tool to keep track.

“As our knowledge has increased on what causes many of these conditions, or what conditions are genetic, we’re really able to individualize the health care screening versus one size fits all,” said Dr. Janice Graham, primary care physician and chief at Kaiser Permanente Lidgerwood Medical Center.

With better details, some people need more frequent screenings or different kinds of test that aren’t typically done until certain recommended ages in the general population, she said.

For example, instead of the medical recommendation about 10 years ago that women should get a mammogram every year starting at age 40, physicians can try to identify higher-risk patients who might need more intensive and earlier screening.

Graham said she might refer a woman to get genetic testing, for BRCA1 and BRCA2 genes, if she recorded having multiple close female relatives who have had breast cancer. That patient would likely start mammogram screenings earlier by age 40, she said.

“We’re really working to individualize what screenings are recommended and when depending on the person’s risk,” Graham said.

But, generally, many patients don’t know specifics about family health history, and they’ll have to send her a message later to fill in details, Graham added. They might know that some relative had a heart surgery without knowing why.

“I frequently have patients who don’t know, and then they end up sending me an email or secured message with details,” she said.

“I’ll clue them into asking did they have a pacemaker? Did they have bypass surgery? Were they in their 40s or 50s, which I consider premature versus if they were in their 70s or 80s?”

She said she’d like to see more families gather such information over a weekend visit. That includes asking about breast cancer among close relatives, as well as ovarian cancer and colon cancer that can run in families.

Other conditions to record include heart disease, diabetes, high blood pressure, high cholesterol and osteoporosis, a medical condition where bones become weak and are more likely to break.

“You and your family members share genes,” says a recent article by the CDC, which offers health history online resources. “You may also have behaviors in common such as exercise habits and what you like to eat.

“You may live in the same area and come into contact with similar things in the environment. Family history includes all of these factors, any of which can affect your health.”

For example, the CDC says that if you have a strong family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you might have a high risk of getting breast cancer, as well. There’s also a high risk for ovarian cancer.

If your relative was diagnosed with breast cancer before age 50, if you have a close relative with ovarian cancer, or if you have a male relative with breast cancer, your doctor might refer you for that cancer genetic counseling.

Another question to ask is if your mother, father, brother or sister had colorectal (colon) cancer before age 50. If “yes,” you are more likely to get the same disease. The CDC suggests talking to your doctor about earlier screenings, perhaps done more frequently, and what other steps to take.

Regarding osteoporosis, the CDC says that depending on factors such as relatives with early fractures, talk to your doctor about screening earlier at about age 55 compared with age 65 for most women.

Another factor to consider is hereditary hemochromatosis, a disorder in which the body can build up too much iron and can lead to serious liver damage and other problems.

If you have a brother or sister with hemochromatosis, you might be more likely to develop the condition. Talk to your doctor about testing and whether you should take steps to lower the amount of iron in your body.

Other CDC family health history tips:

Remember to zoom in on specifics of chronic diseases such as heart disease or diabetes or other health conditions such as high blood pressure or high cholesterol. Has anyone had any other serious diseases such as cancer or stroke? What type of cancer?

Look at death certificates and family medical records from the entire family. Collect health information about parents, siblings, grandparents, aunts, uncles, children, nieces and nephews. Record any major medical conditions diagnosed and at what age, causes of death, age at death and ethnic backgrounds.

Track if your mother, father, sister or brother has diabetes? If so, talk to a physician about screening, as well as diet and exercise strategies that can lower your risk.

Ask details about relatives’ heart disease background. If so, lower risk with a healthy diet, being physically active, maintaining a healthy weight, being a nonsmoker and limiting alcohol use. Screening for heart disease might pinpoint a need to take medication.

Continue to update your family health history record whenever you learn new information.