National Family Health History Day - November 25

Thanksgiving Day is not only a time to gather with friends and family to eat a sumptuous meal and count blessings. It’s also happened to be National Family Health History Day today. The idea is to take a day when everyone in your family is assembled and discuss the family health history, specifically any occurrence of colorectal cancer. Healthcare providers encourage you to use this day to share and care about this and other serious diseases.

Knowing is Not Enough

Has your mother or sister had breast cancer? Does your mother, father, sister, or brother have diabetes? Did your mother, father, brother, or sister have colorectal (colon) cancer before age 50? If you answered “yes,” you are more likely to get the same disease as your parent or sibling and should consider earlier screening. Talk to your doctor about when to start screening and what other steps to take to prevent the disease or find it early. Finding disease early can often mean better health in the long run.

Even if you don’t have a parent or sibling with cancer or diabetes, you might be more likely to get a disease if other people in your family have or had the disease. However, having a family health history of a disease doesn’t mean that you will definitely get it. Knowing your family health history risk can help you—if you act on it. Collecting your family health history is an important first step. Whether you know a lot about your family health history or only a little, take time to talk to your family about their health histories this holiday season. It might not be easy. Your family members might not be used to talking about their diseases or might not want to talk. But starting the conversation is important. Remember, you’re asking not just for your own health, but for the health of everyone in your family.

How to Collect Your Family Health History

Talk to your family.

Write down the names of your close relatives from both sides of the family: parents, siblings, grandparents, aunts, uncles, nieces, and nephews. Talk to these family members about what conditions they have or had, and at what age the conditions were first diagnosed. You might think you know about all of the conditions in your parents or siblings, but you might find out more information if you ask.

Ask questions.

To find out about your risk for chronic diseases, ask your relatives about which of these diseases they have had and when they were diagnosed. Questions can include:

• Do you have any chronic diseases, such as heart disease or diabetes, or health conditions, such as high blood pressure or high cholesterol?
• Have you had any other serious diseases, such as cancer or stroke? What type of cancer?
• How old were you when each of these diseases or health conditions was diagnosed? (If your relative doesn’t remember the exact age, knowing the approximate age is still useful.)
• What is your family’s ancestry? From what countries or regions did your ancestors come to the United States?
• What were the causes and ages of death for relatives who have died?

Record the information and update it whenever you learn new family health history information. 

My Family Health Portrait, a free web-based tool, is helpful in organizing the information in your family health history. My Family Health Portrait allows you to share this information easily with your doctor and other family members.

Share family health history information with your doctor and other family members. 

If you are concerned about diseases that are common in your family, talk with your doctor at your next visit. Even if you don’t know all of your family health history information, share what you do know. Family health history information, even if incomplete, can help your doctor decide which screening tests you need and when those tests should start.

If you have a medical condition, such as cancer, heart disease, or diabetes, be sure to let your family members know about your diagnosis. If you have had genetic testing done, share your results with your family members. If you are one of the older members of your family, you may know more about diseases and health conditions in your family, especially in relatives who are no longer living. Be sure to share this information with your younger relatives so that you may all benefit from knowing this family health history information.

How to Act on Your Family Health History

Knowing about your family health history of a disease can motivate you to take steps to lower your chances of getting the disease. You can’t change your family health history, but you can change unhealthy behaviors, such as smoking, not exercising or being active, and poor eating habits. Talk with your doctor about steps that you can take, including whether you should consider early screening for the disease. If you have a family health history of disease, you may have the most to gain from lifestyle changes and screening tests.

What you can do if you have a family health history of:

Colorectal Cancer

If you have a mother, father, sister, brother, or other close family members who had colorectal cancer before age 50 or have multiple close family members with colorectal cancer, talk to your doctor about whether you should have screening starting at a younger age, being done more frequently, and using colonoscopy only instead of other tests. In some cases, your doctor may recommend that you have genetic counseling, and a genetic counselor may recommend genetic testing based on your family health history.

Breast or Ovarian Cancer

If you have a parent, sibling, or child with breast cancer, talk to your doctor about when you should start mammography screening. 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 cancer genetic counseling to find out if genetic testing is right for you. In some cases, your doctor might recommend taking tamoxifen, raloxifene,  or aromatase inhibitors, drugs that can decrease the risk of developing breast cancer in some women.

Heart Disease

If you have a family health history of heart disease, you can take steps to lower your chances of getting heart disease. These steps can include eating a healthy diet, being physically active, maintaining a healthy weight, not smoking, limiting your alcohol use, having any screening tests that your doctor recommends, and, in some cases, taking medication.

Diabetes

If your mother, father, brother, or sister has type 2 diabetes, you could have prediabetes and are more likely to get type 2 diabetes yourself. But there are important steps you can take to prevent type 2 diabetes and reverse prediabetes if you have it. Take this test to find out if you could have prediabetes. Ask your doctor whether you need earlier screening for diabetes. Find out more about the National Diabetes Prevention Program’s lifestyle change program and how to find a program near you. 

Osteoporosis

This is a medical condition where bones become weak and are more likely to break. A family health history of osteoporosis is one of a number of factors that make you more likely to develop osteoporosis. For example, if you are a white woman whose mother or father fractured a hip, talk to your doctor about screening for osteoporosis earlier (at about age 55, compared with age 65 for most women). You can use the FRAX Risk Assessment tool to learn if you should be screened.

Hereditary Hemochromatosis

Hereditary hemochromatosis is 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 may be more likely to develop the condition yourself. Talk to your doctor about testing for hemochromatosis and whether you should take steps to lower the amount of iron in your body.

Is Family Health History a Non-Modifiable Risk Factor?

Family health history is sometimes used interchangeably with genetics, but family health history captures more than just that. Family health history also includes shared behaviors, environments, and cultures. For example, your mother’s genes may have contributed to her type 2 diabetes and you may share some of those genes, but the fact that she lives in an area where healthy foods are harder to get and where there are few opportunities for exercise also influences her health, and you might share some of these challenges, too.

Your family’s past health history can help you understand what conditions you are at higher risk of developing. However, having a family health history of a disease does not mean that you will get that disease. For some conditions, knowing about your family health history might encourage you to make lifestyle changes, such as exercising or quitting smoking, that can lower your risk of developing that condition. For other conditions, the intervention might include medication or earlier or more frequent screenings. Sometimes taking control of your family health history information to change your future can involve tough choices. For example, while women with a BRCA mutation can choose to have more frequent screenings or take medication, the intervention that works best for many of them—in terms of lowering the risk of developing and dying from breast or ovarian cancer—may be surgery. This topic made news when Angelina Jolie wrote a New York Times Op-Ed about her decision to have a preventive double mastectomy after learning that she carried a BRCA1 mutation. She wrote about her own family health history, of her mother who did not live to see her grandchildren grow up, and of her desire to write her own new chapter in her family health history, one in which she would live to know her grandchildren.

Current guidelines, including those from the U.S. Preventive Services Task Force (USPSTF), recognize the importance of family health history in identifying those at higher risk for a condition. In some cases, the guidelines recommend that those with a family health history get screened at a younger age. For example, if you are a man whose dad had a heart attack before age 50, the USPSTF recommends starting cholesterol screening at age 20 rather than waiting till age 35, the age recommended for men in the general public. Likewise, if you are a white woman whose mother fractured her hip, the USPSTF recommends starting screening for osteoporosis at about age 55, whereas a woman with no risk factors can wait until age 65.

We know that family health history can make people aware of their risk of developing a disease so that they can take steps to prevent the disease. But do they make changes that can alter their family health history in the future? Research suggests that they do. Studies have shown that awareness of family health history of chronic conditions like diabetes can motivate people to engage in healthier behaviors, including eating more fruits and vegetables and exercising more.

Research shows that people who know about their family health history are more likely to get necessary screenings, including cholesterol screening for those with a family health history of heart disease and colon cancer screening for those with a colon cancer family health history. Furthermore, doctors are more likely to discuss these preventive measures when their patients tell them about their family health history.

Relegating family health history to the list of genetic, non-modifiable risk factors suggests that family health history is only about inherited genetic mutations and that families cannot do anything to change their family health, in the past or the future. In doing this, we may do a disservice to those with a high risk family health history, dooming them to repeat the past rather than learn from it. Not only that, but we may take away the control that family health history can give us all, the ability to use the past to change the future. By making use of the many public health interventions available to improve their health, families can show that family health history is indeed a modifiable risk factor.

Sources:

https://nationaltoday.com/national-family-health-history-day/

https://blogs.cdc.gov/genomics/2014/11/13/family-health-history/

https://www.cdc.gov/genomics/famhistory/knowing_not_enough.htm