Forget politics. This holiday season, whenever you gather with family, talk to them about health. The health and medical history of anyone related to you by blood may affect your own health. Genetics as well as habits can play a part: You're at higher risk for medical issues that run in the family. In fact, having at least one first-degree relative with a disease can double your risk, or more.
"Knowing your family medical history gives you and your doctor a better sense of what may happen to you. And you can do something to manage or prevent it," says medical geneticist Wendy Chung, MD, PhD. "Some of us say your family medical history is the cheapest genetic test you can get."
Take advantage of the time together to get the details you need to protect your health. Then, talk to your doctor about the next steps.
Why family medical history is important
"You share genes, environmental factors, customs, and beliefs with your family, so there's a good chance you share some of the risk factors that other members of your family have for diseases like breast cancer, diabetes, and Alzheimer's," says Chung. "I'm not trying to overinflate this, but sometimes knowing a health issue or disease is in your family is information that could be lifesaving."
That said, just because a disease like cancer runs in your family doesn't mean every single person in your family will get cancer. That's where genetic testing can provide greater specificity for members of the family.
What doctors do with family medical history
"Physicians recognize patterns, know what's more common in your family versus the general population, and put together pieces to prevent or catch things early," says Chung. "You may not connect the dots on your own so doctors help guide the patient."
Red flags in family medical history include:
- Consistency
- Something running in the family consistently; more than one family member having the same condition
- Young age of onset
- More than one family member getting a condition at a younger age than the general population with the same condition
- Different manifestations of a single condition in the family
- For example, colon cancer, uterine cancer, and ovarian cancer are each part of a specific condition called Lynch syndrome. Doctors can recognize the pattern.
These flags trigger enhanced surveillance, screening that's more specific or starts at a younger age than is routine, and genetic testing. However, says Chung, "We don't test for every single disease. Testing is expensive. We most frequently test for 'news you can use' right now. We look at family medical history and your symptoms to decide what to test."
Why there is a greater emphasis than ever on family medical history
Simply: As more genetic tests become available, more people take them to investigate their family history.
"At Columbia, genetic testing is part of our emphasis on precision medicine-the right treatment for the right patient at the right time," says Chung, who provides genomic care to patients and also is a researcher.
There are many common health conditions in the United States, including cancer, heart disease, diabetes, Alzheimer's disease. An individual is not at high risk for all of them.
Knowing information about genes helps doctors tailor treatments and prevention strategies.
Some people have specific conditions in their family, such as cardiomyopathy, arrhythmia, and other issues that are all linked to a single genetic factor. For families with greater cancer risk, do family members need to be more careful about breast or prostate cancer? When does that cancer risk start? "Family medical history is information that can immediately be put to use for your health," says Chung.
What family health history you need
1. A list of people in your blood-related family who have died and, as much as possible, their:
- Cause of death
- Age at death
2. A list of people in your blood-related family who have (or had) a serious health condition, either common or rare.
"If you see a recurring condition in your family, it can give you hints about your health," says Chung. "And there may be patterns today that weren't there 10 years ago when family members were younger."
If you're thinking about having children, you also need:
3. A list of blood-related children in your family who died in childhood or have (or had) a serious health condition, such as:
- Birth defect
- Serious developmental or intellectual disabilities
- Seizures
4. A list of blood-related family members without any children
- Was this by choice or a health condition?
Who to ask about health history
Anyone related to you by blood, especially first-degree relatives: parents, siblings, and children. Then aunts, uncles, grandparents, cousins.
Chung suggests starting with people who know the most. "Many families have one person who knows the collective family history better than others. Sometimes that person has a medical background, is more health literate, or has been around longer, or is chatty and knows the family stories and can put it all together."
Do not include in your family health history anyone who is not related to you by blood.
What if you are adopted?
"If you were adopted, or had a gamete donor, or your family was killed in a war or the Holocaust, or you're an immigrant and lost touch, do not worry," says Chung. "Family health history can reveal itself in interesting ways."
Widely available genetic testing, through ancestry search sites and elsewhere, links people to relatives and reveals hidden health issues. Talk to your doctor about tests that are right for you.
The best way to talk about family medical history
"Most people want to help their family and protect them from health problems. And one good thing about COVID is it's prompted more people to share more health details," says Chung, "but realize there can be sensitivities."
People may not share information because they consider it sensitive. Mental health issues or a father who wasn't involved, for example, can make people feel awkward. Do not push.
A good way to start this conversation is focused on broader family history. Use the time together as a way to celebrate, and let the conversation evolve into medical matters.
Bottom line: You want to know your family's medical history to keep yourself and your relatives healthy and get ahead of anything that may be coming your way.
References
Wendy Chung, MD, PhD, is a clinical and molecular geneticist who leads the Precision Medicine Resource in the Irving Institute at Columbia University. She's an expert in human genetic research of monogenic and complex traits, including diseases such as breast cancer, pancreatic cancer, congenital heart disease, pulmonary hypertension, inherited arrhythmias, cardiomyopathies, obesity, diabetes, congenital diaphragmatic hernias, and autism.
