Family medical history is vital but often unknown

THE BALTIMORE SUN

What did your grandfather die of?

What's the worst illness your aunt ever had?

Does your mother take any medication? If so, for what?

What's your father's cholesterol level?

If you don't know the major illnesses and causes of death for all your siblings, parents, aunts, uncles and grandparents, medical experts urge you to find out.

It's not being nosy, they say. Knowing your family medical history is crucial to your health -- and your children's health.

"Family history is second only to personal history as a guide to your medical risks," says Dr. Julie Baller, an assistant clinical professor of family and community medicine at the University of California's San Francisco Medical Center.

"Once you know your family history, you can take steps to minimize your risks, and quite possibly add years to your life."

"You wouldn't think of driving across Mexico without a road map," says Dr. Henry Lynch, an oncologist, the chairman of the department of preventive medicine and the president of the Hereditary Cancer Institute at Creighton University School of Medicine in Omaha, Neb. "Family medical history is a map that contains important landmarks to your health."

"Every family should compile a 'genogram,' a medical family tree," says Dr. Mack Lipkin, the director of primary care and an associate professor of medicine at Bellevue Hospital-New York University Medical Center. "It takes energy, but it's very useful. Treasure it. Update it periodically. Keep it right next to the family Bible."

Unfortunately, family history is an area both patients and physicians may neglect.

"Most doctors don't have up-to-date knowledge of hereditary factors in health," says Patricia Ward, a genetic counselor at Baylor College of Medicine in Houston.

"And even when they do, it's hard to take a complete family history in the typical 15- to 20-minute office visit. That's why people need to know this information and bring it up themselves."

Which family members are important?

"First- and second-degree relatives," Ms. Ward says. "First-degree relatives are your parents, siblings and children. Second-degree relatives are your grandparents and blood-related aunts and uncles."

"More than 2,000 diseases run in families," Dr. Lipkin says. "Just about everyone has some family history of heart disease, cancer and stroke, which account for more than half of U.S. deaths.

"The red flag is a close relative who developed any of these diseases, unusually early in life. If your father died of a first heart attack at age 80, you don't have to be too concerned. But if he died at 48, then you need to take a long, hard look at your risk factors and keep them out of the danger zone."

Here's a list of diseases worth paying attention to if they've shown up in your family medical tree.

* Alcoholism: Alcohol abuse contributes to an estimated 10 percent of U.S. deaths, including cirrhosis, accidents and several cancers.

"Alcoholism is strongly familial," Dr. Baller says. "If any close relative is an alcoholic, I'd say don't drink. That's not easy, but in recent years it's become more socially acceptable not to."

* Allergies: Hay fever sometimes runs in families, Dr. Lipkin says, but polyallergy, which involves a combination of hay fever, eczema and food sensitivities, appears to be more strongly familial.

* Cancer: Colorectal, breast and ovarian cancers often run in families.

Colorectal cancer is the leading cancer killer among non-smokers. One relatively rare form of the disease (familial polyposis) is strongly genetic, but many cases of colorectal cancers have inherited components.

"If any first- or second-degree relative has had colorectal cancer," Dr. Lynch says, "especially if they developed it before age 50, you're at increased risk. Make sure your doctor knows your family history and have yourself examined regularly starting in your 30s."

Breast cancer also tends to run in families.

"If any first- or second-degree relative developed breast cancer before menopause, you're at considerable risk," Dr. Lynch says.

"Be sure to look at your father's family as well as your mother's," he adds. "If you have a family history, learn self-exam and perform it every month. Have a physician examine you regularly. And don't wait until you're 40 to start getting regular mammograms. Start having them in your 20s or 30s."

"A woman with a strong family history of breast cancer might also decide to have her first child before age 30," Dr. Baller says. "That helps reduce breast-cancer risk."

Ovarian cancer is difficult to detect early and treat successfully. However, women who take birth-control pills cut their risk by more than half.

"The Pill has gotten a lot of bad publicity," Dr. Baller says. "But for anyone with a family history of ovarian cancer, it can be a lifesaver. You don't even have to use it that long. If you take the Pill for a few years, the protection against ovarian cancer lasts at least 10 years after you stop taking it."

* Cystic fibrosis: Approximately one child in 1,500 is born with this genetic disease, which impairs breathing and shortens life.

You need two CF genes to get the disease, one from each parent. About 75 percent of people who carry one CF gene can now be identified with a blood test.

If anyone in your family -- including cousins -- has cystic fibrosis, consult a genetic counselor before you attempt to conceive children.

* DES: Any woman whose mother took this hormone while pregnant is at increased risk for a rare vaginal cancer, infertility and other medical problems. Physicians prescribed DES from the late 1940s through the 1960s in the mistaken belief that it prevented miscarriage.

Tell your doctor if your mother took any prescription drugs while pregnant with you -- especially if she had a history of miscarriage before you were conceived.

* Diabetes: "If one of your parents has diabetes, you have a 10 to 20 percent chance of developing it," Dr. Lipkin says. "If both parents have it, your risk rises to 50 percent."

An estimated 10 million Americans have diabetes, and complications from the disease are a leading cause of death.

"If you have diabetes in your family, that's a clear message to stay at your recommended body weight," Dr. Baller says. "The disease is strongly associated with obesity. Eat a low-fat diet, and get regular exercise."

* Ethnic diseases: Some diseases run not only in families, but in ethnic groups, Ms. Ward says.

Sickle-cell anemia, a potentially fatal blood disease, primarily strikes black people and those of East Indian descent.

Greeks, Italians and Asians are at risk for another potentially fatal inherited blood disorder, thalassemia.

And Tay-Sachs disease, a fatal neurological disease, strikes people of French Canadian or Eastern European Jewish descent.

* Glaucoma: Approximately one in 25 Americans develops this leading and "strongly familial" cause of blindness, Dr. Lynch says.

Anyone with a family history of glaucoma should be screened regularly because early detection and treatment can save vision.

* Heart disease and stroke: Familial risk factors for heart disease include high cholesterol and high blood pressure (hypertension). Hypertension is also a key risk factor for stroke.

"A patient of mine recently had a cholesterol test that came up 240," Dr. Baller says. "That's high, but not terribly high. Usually I'd simply recommend a low-fat diet to bring it down, but this man's father had died fairly young of a heart attack, so we decided to treat him more aggressively, with a low-fat diet plus cholesterol-lowering medication."

High blood pressure can also be reduced with a low-fat, low-salt diet; weight loss; moderate exercise and medication.

* Mental illness: "Schizophrenia, depression, manic depression and panic disorder all have genetic components," Dr. Lipkin says. "If close relatives have any of these conditions, or any history of suicide attempts, mention it to your physician and consider psychological evaluation."

* Obesity: You're "obese" if you weigh 20 percent more than the recommended weight for your height and build.

"We've known for years that obesity runs in families," Dr. Lipkin says, "and recent studies have strengthened the case that it's under genetic control."

Obesity is a risk factor for diabetes, hypertension, heart disease, stroke and several cancers including breast and colorectal.

Those with a family history of obesity should work with a physician and registered dietitian to keep their weight under control.

* Other diseases: "For every organ system without exception there are diseases that run in families -- kidney diseases, gastrointestinal conditions, you name it," Dr. Lipkin says.

"Heart disease, cancer, stroke, diabetes, alcoholism and mental illness are the major concerns, but the more you know about your relatives' medical histories, the better."

A family history of disease in no way dooms you to serious medical problems. Nor does a robust, long-lived family guarantee you'll reach 100.

"But," Dr. Baller says, "knowing your family history provides information you can use to make better-informed choices about how you live your life."

ADOPTION AND MEDICAL HISTORIES

Compiling a family medical history is hard enough when all it takes is a few phone calls. But current state laws often make it impossible for adoptees to learn about their birth parents' family medical histories.

"Adoption records are often completely sealed, which means adoptees can't get any information," says Dr. Henry Lynch, an oncologist, the chairman of the department of preventive medicine and the president of the Hereditary Cancer Institute at Creighton University School of Medicine in Omaha, Neb.

"That's a real disservice," he adds. "Adopted children should have the right to learn their birth parents' medical histories."

Some states now permit adoptees to unseal their records. Consult an attorney about the rules in the state where you were adopted.

Dr. Lynch says anyone considering adoption should make every effort to learn the family medical histories of the child's birth parents.

Some agencies now provide this information routinely, but you may have to make special arrangements to obtain it from others.

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