Why and How to Put Together a Family Medical History

Katherine Hobson

Most of us are aware of our family medical history on some level -- we're pretty familiar with our parents' recent ailments, for example, and probably could tell you what our grandparents died from. But if pressed to be more specific, we might not have all the details -- and those can be important. The information a detailed family medical history offers might change your own medical care 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.

Here are eight tips for compiling a family medical history that will do the job:

Start with those closest to you

Your first-degree relatives -- parents, brothers or sisters, and children -- are the most important to gather information about, says Michael Roizen, chief wellness officer and chair of the Cleveland Clinic's Wellness Institute. Reaching farther into the family tree -- details on grandparents and aunts and uncles, nephews and nieces, and half-siblings -- can sometimes be helpful, he says. But beyond that, there's not likely to be a ton of gainful information, he says. (Others say that information from cousins and great-uncles and great-aunts can be helpful, so if you can get it, it can't hurt. But there's no need to corner your second cousin twice-removed at the next family reunion.) If you're adopted, you may be able to get information with a little digging; if you have no medical information about your biological 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 is the obvious information to record for each of your deceased relatives. But it may not be as important as information about earlier diseases or conditions. 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 about any chronic or previous problems.

Age is key

You will 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, is one of the red flags that 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 to ask about. 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 on 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. Now people are more likely to record a family medical history as a list or chart and store it with their other medical information. But don't lock it away in a drawer -- it should be a "living document," Keiles says. One easy system: the surgeon general's family health history initiative. The office's Family Health Portrait tool lets you enter information about your health issues and your relatives', then see it all displayed in a pedigree format. You can print out the information or save it. (It's not actually stored on the government's site but on your own computer.) You can also print out a form and record the info by hand.

Show it to your doctor

He or she should ask for a family medical history when you first visit. If there's something that stands out-early onset of cancer in several close relatives, for example, or a continuous string of men who died in their 50s from a heart attack -- he or she may recommend (or you can ask about) a visit to a genetic counselor, says Roizen. In some cases, your actual 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 family history of prostate cancer may tilt you in favor of taking the controversial prostate specific antigen, or PSA, test. And a family history of heart disease may mean a discussion with your doctor about taking daily aspirin.

Learn from it

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

It's rare that a gene destines you to a certain disease; more likely is that you're simply at higher risk than the average person.

And in many cases you can modify that risk.

"I look at it this way," says Roizen.

"Every one of us has genes that make us vulnerable. 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 some day.

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 the information you find. So in the spirit of family, offer to share.


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Health - Why and How to Put Together a Family Medical History