Tracing Your Medical Roots: Crucial Information Might Save Your Life

Katherine Hobson

Jennifer Bojanowski of Kailua, Hawaii, has always been painfully aware of her family medical history. How could she not be? Her mother died of breast cancer at the same age Bojanowski is now--38. Her grandmother had the same disease, as well as pancreatic cancer. Several great-aunts also suffered from breast cancer. It all added up to a portrait that clearly "had implications for my health," says Bojanowski, who received genetic counseling and testing a few years ago.

Though no known genetic red flag was found, she now undergoes frequent screening for breast and ovarian cancer. She even became a genetic counselor herself to help other people deal with the same grief and questions she has faced.

Most people are aware of their own family medical history on some level--pretty familiar with their parents' recent ailments, for example, and probably with what their grandparents died from. But if pressed to be more specific, they might not be able to give all the details--and those can be important. A family medical history might change your own healthcare or provide a needed incentive to make better lifestyle choices.

"Your family history is probably the best predictor of risk for your own health," says Steven Keiles, president of the National Society of Genetic Counselors. So pick a relaxed time and start quizzing your relatives.

TIPS

--Start with those closest to you. Your first-degree relatives--parents, brothers or sisters, and children--are the most important to research, says Michael Roizen, chief wellness officer and chair of the Cleveland Clinic's Wellness Institute. Reaching further into the family tree--details on grandparents and aunts and uncles, nephews and nieces, and half-siblings--may sometimes be helpful, he says; beyond that, there's not likely to be much gainful information. (Others say that information from cousins and great-uncles and great-aunts can be helpful.) If you're adopted and have no medical information about your birth parents, check back with the agency or organization that facilitated the adoption.

--It's not just about death. The age at death and the ailment that caused or immediately preceded death are the obvious data to get for each of your deceased relatives. But don't ignore earlier problems. Did your father, who died in his 80s of heart failure, have a previous bout with colon cancer or experience high blood pressure for most of his adult life? Make sure you ask.

--Age is key. You also want to record the age at which medical conditions arose, if that information is available. "Early" means different things for different diseases, but generally, the younger a person is when a disease rears its head, the more likely it is to have a genetic component. Having two first-degree relatives (a mother, daughter, or sister) diagnosed with breast cancer before age 50, for example, may mean you should be tested for specific mutations in the BRCA1 and BRCA2 genes.

--Think broadly about diseases and conditions. Cancer, heart disease, diabetes--those are the obvious potential killers. But go further. Ask (delicately) if deceased relatives were obese. Were they depressed or otherwise plagued by mental illness? Probe for developmental problems; addictions to alcohol, drugs, or cigarettes; multiple miscarriages or stillbirths; and birth defects, even if repaired, says Keiles.

Context is also important; if someone had heart disease early but also smoked from the age of 16 on and never got any exercise, those are mitigating circumstances that your doctor should know about when assessing your own risk.

--Write it down. "In the old days, people kept family Bibles" in which they recorded births and deaths, says Judy Garber, director of the Cancer Risk and Prevention program at the Dana-Farber Cancer Institute, Boston, Massachusetts. Now people are more likely to record a family medical history as a list or chart and store it with other medical information. But don't lock it away; it should be a "living document," Keiles says.

One easy system: the surgeon general's family health history initiative (http://www.hhs.gov/familyhistory/). The office's Family Health Portrait tool lets you enter information about your health issues and your relatives' and then see it all displayed. You can print out the information or save it. (It's not actually stored on the government's site but on your own computer.)

--Show it to your doctor. If something stands out--say, an early onset of cancer in several close relatives, or a string of men who died in their 50s from heart attacks--your doctor may recommend a visit to a genetic counselor for a better understanding of your own risk, says Roizen. In some cases, your medical care may change. For example, a strong family history of colon cancer or polyps may mean you should be screened before the usual starting age of 50. A history of heart disease may mean a talk with your doctor about taking daily aspirin.

--Learn from it. Even if there are no additional medical steps to take, knowing you have a heightened risk may inspire you to focus on factors you can control: tobacco use, diet, physical activity, or alcohol use, says George Kikano, professor and chair of the department of family medicine at Case Western Reserve University, Cleveland, Ohio.

It's rare that a gene destines you to a certain disease; more likely, you're simply at higher-than-average risk. And in many cases you can modify that risk. "Every one of us has genes that make us vulnerable," says Roizen. "Very few of us know which ones they have, and family history gives us clues."

--Share it with your relatives. If you and your grandmother both had breast cancer in your 40s, that's information your children will need to have someday. Yes, even boys--they might be at higher risk of breast cancer themselves and also may pass on a mutation to their future daughters, Garber says. Your siblings, nieces, and nephews may also benefit from what you find. So in the spirit of family, offer to share.

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Tracing Your Medical Roots: Crucial Information Might Save Your Life