A family tree for better health

Fleshing out your family tree isn’t just a popular past time — it’s good for your health too. Heredity plays a role in your chances of experiencing certain health issues from allergies to Alzheimer’s disease. The more you know about your family’s medical history, the better you and your doctor can determine your risk and target the best strategies to prevent, diagnose and treat these issues. The information doesn’t just affect you — it can also help you make crucial decisions for your children and parents as well.

However, diving into your gene pool doesn’t have to mean a trip to the nearest lab. Chatting up your relatives can be even more effective than expensive genomic tests when it comes to uncovering risk, say experts. Consider the recent study out of the Cleveland Clinic which compared the results of genomic testing versus a family health tree in 44 participants (22 cancer patients and their spouses).

The results might surprise you: both the family history and the genomic test labelled individual as high risk about 40 per cent of the time. The catch: as often as not, the two approaches didn’t agree. In fact, the genomic tests missed the nine people who had a strong family history of colon cancer, including five people with a telling genetic mutation. (Red the full article here.)

This isn’t the first time experts have warned about gaps. Genomic tests are broad and often don’t include specific genes which doctors know contribute to illness — like an uncommon genetic mutation — and can give recipients a false sense of security. However, a family history can warn doctors that specialized testing or genetic counselling is required.

Unfortunately, though experts call family health histories “the best genetic tool we have”, they’re something we often overlook. If you’re not sure where to begin, we’ve got some help.

How to get started

– Make a list. Who should you talk to? Experts recommend covering at least three generations, including grandparents, parents, uncles, aunts, siblings, cousins, children, nieces, nephews and grandchildren (as applicable).

– Share your goals. Explaining what you’re doing and why it’s important can help people open up with honest answers. Need an icebreaker? Try something along the lines of: “I’m compiling a family medical history to help us understand issues that could affect our health. I was wondering if you could tell me more about…”

Offering to share your findings can also motivate people to come clean — after all, the information benefits them too.

– Respect privacy. Some people will be “fountains of information” while others may be hesitant or unwilling to discuss such personal issues. If someone doesn’t want their information shared beyond you and your doctor, respect their confidence.

– Talk at family gatherings. Take a notepad with you to your next family event. The holiday gatherings are a good time to gather information when everyone is together, but any event will work — like family reunions and birthday celebrations.

– Provide alternatives. Face-to-face discussion works for many people — especially older relatives — but some might feel more comfortable speaking over the phone or via mail or email.

– Be a good listener. Let’s face it: talking about health can be embarrassing, and some people are ashamed to discuss things like mental illness. Experts advise to take your time and keep an open mind. Acknowledge that you know it’s a difficult topic to discuss, and stay clear of any judgment and criticism.

– Look at outside sources. Your relatives likely won’t be able to tell you everything, but hospital records, obituaries, diaries, baby books, letters or birth and death certificates can provide answers. Even old photographs can reveal some secrets — like a hunched back that could signal osteoporosis.

If you’re adopted, experts recommend getting in touch with the adoption agency as a good starting point.

– Consider both sides. To get a complete health picture, you’ll need to look at both sides — especially for sex-specific issues like breast or prostate cancers. For instance, studies reveal that many women overlook the risk of breast cancer from their father’s side

– Find tools to help. Thanks to the growing popularity of family health history, there are many online tools and downloadable kits now available. Here are some places to start:

US Surgeon General: My Family Health Portrait
Utah Department of Health: Family Health History Toolkit
National Society of Genetic Counsellors: Family History Tool
Inherited Health (basic services are free)

What questions to ask

Once you’ve got a list of people who are related to you by blood, it’s time to do some digging. Here’s what experts say you should know*:

– What traits run in the family? If you’re having a hard time starting a conversation, experts advise to begin with less threatening topics like eye colour, allergies or when people first started wearing glasses.

– Where were family members born? True, you’ll want to know when someone was born to know how long they lived, but people of certain ethnic backgrounds may be at higher risk for certain health issues.

– What family members have had health problems — and which ones? Be sure to ask about conditions where there’s a known genetic link — like cancer, heart disease, diabetes, dementia, arthritis, mental illness, stroke, hearing or vision loss and high blood pressure. You could be at a higher risk for a certain conditions — like certain cancers and heart disease — if two or more of your family members had it.

It’s also important to note patterns of illness — like if an individual has had more than one type of cancer, or if they have related conditions like heart disease and diabetes.

– How old were they when the problem started or was diagnosed? There’s a big difference between developing heart disease or cancer at 35 versus after age 80. In general, the younger the age of onset the more reason for concern. In some cases, issues that show up before the age of 50 should be considered “red flags”.

Also, beware that it can take years to get an accurate diagnosis for some conditions, like certain types of arthritis and autoimmune disorders.

– How old were family members when they passed away, and what was the cause of death? Don’t leave any blanks — expert warn to take note if the cause was unknown. Remember, we have better awareness and diagnostic tools today than in the past. It’s possible that older relatives were never officially diagnosed with a condition.

– Were they any reproductive issues? Infertility, miscarriages and birth defects should also make your list because they can affect future generations.

– What lifestyle habits do family members have? We don’t just share genes with our family — we often have similar habits and live in the environment. Choices like smoking, exercise, weight, addictive behaviours and exposure to toxins in the environment all play a role.

Focus on the positives too: if you have healthy, long-lived relatives, ask them to share their longevity secrets. Also, what successful treatments and strategies are people using to manage their health issues? Their successes might work for others too.

– What allergies do people have? They may seem minor, but this information could reveal what food and medication allergies your family is susceptible to — especially if they developed the allergies as adults.

Sounds like a lot to remember? A checklist or questionnaire can help you cover all the bases — you can find them in the toolkits and print up your own version.

(*Compiled from online toolkits and advice.)

What should you do with this information?

Once you’ve got a fairly bushy tree, share the information with your doctor and have a talk about anything that concerns you. You and your doctor can use this information to help determine what lifestyle changes you can make and what screening tests you may need and when. For instance, if there’s a family history of a certain cancer, your doctor may recommend routine screening sooner than usual. If you’re currently dealing with unknown health issues, the information could point the way to the right test.

Another warning from experts: don’t let the results upset you. A high risk for a certain disease won’t guarantee you’ll be affected. There is still a lot doctors don’t know about heredity, but they do know that controllable factors like lifestyle play a big role in preventing and delaying the onset of illness.

Remember, there is a lot we can do to improve and maintain our health, and your family health history is just another tool in your arsenal.

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ON THE WEB

Want to know more about family medical histories? Most sources offer the same basic guidelines. Here are some places to start:

About.com: Family Health History
American Medical Association: Family Medical History
The MayoClinic.com: Medical history: Compiling your medical family tree
NIH Senior Health: Creating a Family Health History
U.S. Centers for Disease Control and Prevention: Family Health History

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