Why You Need To Know More About Your Family’s Medical History
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Every time you see a new doctor, you’re handed that new patient intake form. It asks all sorts of questions about you, like how often you drink, whether or not you smoke, what type of exercise you do, and whether or not you’ve had any surgeries. But it also asks about your family’s medical history. I always feel a little bit ashamed when I get to that part of the form because, there are some pretty major pieces of information surrounding my family’s health that I just don’t know. I should be able to answer, for certain, whether or not anyone in my family has had cancer or a heart attack. But the truth is that some of that information, relatives haven’t been clear about. I vaguely remember this cousin or that uncle being hospitalized for something…at some time. Maybe it was a heart thing? Didn’t somebody catch one cancer in the early stages?
The truth is that many people don’t know much about their family’s medical history. It’s not like it’s something people want to talk about when they get together. When we’re with loved ones, we want to celebrate life – not dwell on the things that threaten it. Plus, many people think of themselves as individuals first, and part of a bloodline second. We like to think that our choices – our individual decisions – will shape our fates more than anything in our DNA could. But acknowledging the power of your genetics in your health is the first step to taking a bit more control over it. We spoke with Dr. Lauren W. Powell, MD (pictured below) about the importance of knowing your family’s medical history.
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What genetic conditions might surprise us?
There are some conditions that are widely understood to be genetic, like Crohn’s disease or high cholesterol, but we asked Dr. Powell what conditions patients are often surprised to find can run in the family. “I think a lot of patients are surprised that some of the cancers are [hereditary]. For instance, some forms of breast cancer are genetic and others aren’t…sometimes there’s some confusion there,” she says. “Same thing with colon cancer. I think some patients are surprised that some of those can also be genetic.” Research has found that as many as 10 percent of breast cancer cases may be hereditary.
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Which conditions should you look out for?
While it’s important to have a comprehensive idea of your family’s medical history, there are some conditions that, should they run in your family, it’s particularly critical you take note of with your doctor. Powell listed breast cancer, prostate cancer, and colon cancer as a few. “It’s important to know not just if this condition runs in your family but at what age. So at what age was that person in your family diagnosed? That’s going to affect when we do your screening and how often we do your screening.” Traditionally, between the ages of 40 and 44, a woman’s doctor should offer for her to begin yearly mammograms, and women between the ages of 45 and 54 should be receiving annual screenings. The starting age can be earlier though depending on a family’s history with cancer.
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Here’s the information you should gather
The more specific you can be in detailing your family’s medical history to your doctor, the better they can plan your treatment. “The ideal situation is we hear, ‘Aunt Lucy had breast cancer at age 40.’ That’s helpful. To take it a step further, did Aunt Lucy have surgery, and that’s it? Or did she have to do chemo and radiation? That also gives us a cue into the kind of disease the aunt has,” Powell says. “Any cancers you definitely want to know specifically what organ did it affect, what age was the diagnosis, and then, what treatment did they have? Knowing simple things like, after your aunt was diagnosed with cancer, did she live much longer after? Did she die from the cancer? Those things are important.”
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Which conditions commonly afflict the Black community?
“Sickle cell, beta-thalassemia, and G6P deficiency are conditions in Black families that are genetic,” Powell states. Both sickle cell and beta-thalassemia are blood disorders, and the CDC reports that sickle cell disease impacts 1 in every 365 Black Americans. Research has shown that beta-thalassemia is particularly active amongst Black males. G6P deficiency – formally Glucose-6-phosphate deficiency – is a condition that predominantly affects males, and occurs more in Black men than other groups. It’s a condition characterized by the lack of an enzyme, which causes red blood cells to break down prematurely, and cause issues like shortness of breath, dark urine, and rapid heart rate.
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Where do genes and environment interact?
“There are other conditions that affect African Americans at a disproportionate rate and we know that these conditions have a genetic predisposition, but the environment and lifestyle play a huge role, and those are different lung diseases…heart disease, diabetes, strokes, hypertension,” Powell states. “Genetics and lifestyle will play roles.” Studies have shown that one’s lifestyle can have a significant impact on how these conditions play out in one’s life. Even changing one’s diet can drastically improve cholesterol levels, and diet and exercise can help delay or prevent Type 2 diabetes for those for whom it runs in the family.
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A healthy lifestyle can feel unattainable
“We also know that sometimes the healthcare system itself can be a barrier to communities getting adequate healthcare. Oftentimes in underserved communities there are areas where there’s decreased access to health care. There’s food deserts…decreased access to a healthy lifestyle,” Powell says. The food desert of which Powell speaks has been well-documented. Studies have found that there are on average 2.4 fast food outlets for every square mile in Black neighborhoods compared to only 1.5 per every square mile in white neighborhoods.
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Good healthcare isn’t always a given
Powell mentioned a lack of good healthcare in Black neighborhoods – something that’s also been well-documented. One study found that societal factors like lack of access to health care play a larger role in prostate cancer-related deaths among Black men than genetics do. Even when there is access to healthcare, something else could be at play. Research has found that minority patients tend to have better health outcomes when treated by a physician of their same race. It opens the lines of communication and results in a more fluid dialogue. But with minorities often lacking in the medical field, this ideal circumstance isn’t always common.
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Why does the family remain quiet?
When asked why many genetic conditions remain under wraps, Powell states, “I think sometimes older people want to keep certain health conditions a secret, like they don’t necessarily want to bother their families or be a burden and so they don’t openly talk about them.” It can also be difficult for parents to discuss their mortality with their children. When they’re used to being in the strong caretaker role, showing any weakness like physical illness can feel unnatural. If you are dealing with a parent who doesn’t want to discuss these things, you might need to show them that it’s okay for you to see them as less than superheroes and more as vulnerable people.
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Sometimes information is missing
“Another reason people may not know parts of their family history is that sometimes the patient themselves doesn’t know it enough in detail to be able to explain it to somebody else,” Powell says. Sometimes, for example, she’ll ask a patient if cancer runs in the family, and the patient will say, “Oh my grandma had cancer and it was all over…or I think it was in her lady parts…” If the information provided isn’t specific enough, Powell says doctors can’t use it to decide how to manage the patient. Age may have something to do with communication lapses between patients and doctors too, as one study found those under the age of 65 aren’t as likely to report feeling seen or heard by their doctors compared to patients over the age of 65.
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Record-keeping could be lacking
“We’re not openly having the conversation. We’re not recording it so that this information can be passed down,” Powell says. Again, she noted that patients often just don’t understand their condition enough to talk to other family members about it. Though you might be in the habit of leaving the record-keeping to your medical professional, it could benefit future generations to stay on top of keeping those records yourself. As you move around from one doctor to another and go through periods of good and bad health, you may not notice patterns arising. But keeping records and noting patterns can provide valuable insight for future generations in your family.
