Dr. Lisa Ball discusses how family history affects your health.
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Family History and Your Health
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Learn more about Lisa Ball, DO
Lisa Ball, DO
Lisa Ball, DO is a caring and reputable family physician serving the community of Saint Petersburg, Florida. Dr. Ball attended the Lake Erie College of Osteopathic Medicine, where she received her medical degree, and completed both her internship and residency in family practice at Bayfront Medical Center. Dr. Ball is a part of BayCare Medical Group. During her consultations, Dr. Ball fully explains patients’ conditions and helps them choose an appropriate treatment plan. Dr. Ball is devoted to ensuring the longevity of her patients’ health and developing long-lasting relationships with them. She takes her time to understand symptoms and give correct diagnoses to ensure the continued health of all her patients.Learn more about Lisa Ball, DO
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Family History and Your Health
Melanie Cole, MS (Host): Welcome. Today we’re talking about family history and your health. It’s a very important topic. You need to know what your family health history is so that you can be your own best health advocate. My guest is Dr. Lisa Ball. She’s a family medicine physician at BayCare. Dr. Ball, thank you so much for joining us. What role does inherited trait play in developing cancer and heart disease? How prominent is genetics in development of some of these diseases?
Lisa Ball, DO (Guest): Well, it can be very prominent depending on which cancer we’re talking about or which disease process we’re talking about. So family history is important in itself to know the patients, their lifestyle, what they grew up with, but also important because they may need screens for certain cancers earlier. Or if they have a predisposition for heart disease or diabetes, we would want to know that family history.
Host: So then what is important to know? What information do you want patients to know about family history of disease? What questions should they be asking older relatives and even cousins?
Dr. Ball: Right. So a lot of people want to know which family we’re even referring to. So the most important with family history would be your immediate family members. That would be your parents, your brothers, sisters, or your children. So any cancers with them is definitely very important. But we also want to know with grandparents, aunts, uncles, nieces, nephews. If there’s anything significant with them, we ask that as well. So when you speak with your family, you would want to ask for sure with any cancers with anybody. What age they may have been diagnosed, what cancer it was. If they passed away, what age they were when they died. Then the cause of death. It may not always be the cancer that was the cause of death.
Host: Well, that’s really a good point. Dr. Ball, how important is the age of onset of a particular condition? If a family history of heart disease or stroke occurred before the 1940s, for example, when medical care may have been a contributing factor or inaccessible, how important are those sorts of things as far as that genetic trait?
Dr. Ball: That’s still incredibly important, especially with early heart disease, because there are genetically linked factors that can cause heart disease despite the fact that the parent smoked, or they were inactive. There are for sure heart disease processes that can affect the patient if the parents died at a young age. So heart disease would be a big one if they had an early age at onset. Additionally, a big one would be any cancer at a young age, specifically colon cancer. If your immediate family member is diagnosed with colon cancer, we actually screen the patient 10 years prior to the age of their diagnosis. So the typical screening age for colon cancer is 50. Let’s say if your parent was diagnosed at 45, we would screen the patient at 35.
Host: Well then if you find these things out and you find out that someone in your family had colon cancer at a younger age, when is it that you start thinking about genetic counselling? What can you expect? How can you plan for even a pregnancy if you find out that these things are risk? What do you want them to know about when and why someone might be referred for genetics counselling?
Dr. Ball: Right. So if we have family history of genetic markers then we would refer to the patient for genetic counselling and testing for themselves. So a big one that patients ask about and is very common is the BRCA testing. That is the one that we know is genetically linked to cause breast cancers, pancreatic cancers, and a few others. So typically the patient would be aware that their immediate family member had a BRCA gene. If that happened, we would refer for genetic counselling and testing for the patient. When you ask specifically about their concerns—if it’s a female—for getting pregnant and their risk for things like that at a young age, that’s what the counselor would speak to them about.
Host: So let’s talk about some specific conditions. Colon cancer, for example. Some of them, as you said, if you have a genetic predisposition then you might need to be screened a little bit earlier. Tell us about colon cancer.
Dr. Ball: Right. So there are a few methods that—We follow the United States Preventative Task Force. So we can just say Task Force when we speak about it. We follow typically the Task Force guidelines with cancer screening. The typical one, still, is a colonoscopy. That’s still the gold standard. That would be at age 50 and every 10 years if normal for an individual that’s not at high risk. But if an immediate family member has colon cancer, whatever age they were diagnosed we would screen the patient 10 years prior. In those settings, because the family member had colon cancer, the patient would be offered and hopefully choose to do the colonoscopy as their screening because that would be a better screening method for them as opposed to someone who’s low risk and can do stool testing and other options for screening.
Host: Well, we’ve already mentioned breast cancer and the BRCA mutation. This is a big one. There are certain cultures that are more at risk. I mean there’s a lot that goes into this and now we’re finding out the risk for ovarian and, as you said, pancreatic. What do you want us to know about the BRCA mutation and breast cancer and family history of breast cancer and when we should be looking to get screened if there’s this risk?
Dr. Ball: Right. So breast cancer screening actually was kind of a controversy a few years ago because the task force recommends mammogram screening in age 50 to 74. I don’t know if the listeners remember. Typically 40 and above is recommended in other guidelines. So that became kind of a controversy of should we wait until 50, but really that’s where family history comes in. It is important to consider earlier testing based on the patient’s family history. So if the family member had a known BRCA positive test result, the patient should be tested for that. There are difficult times to get insurance to cover BRCA testing. If a patient doesn’t know a family member had a BRCA gene, then we can try to ask them questions to see if they're still at risk, which would be things like cancer in both breasts in the family member or breast cancer in the male relative or certain Ashkenazi-Jewish, which you mentioned certain cultures. So there are other ways to screen despite not knowing the family member’s BRCA test results. In those high risk individuals, we would want to screen earlier than 50.
Host: As we’re talking about all of these Dr. Ball, and one of the biggest questions is what do you do with that information? If you find out that you have familial hypercholesterolemia or heart disease or any of these things, what does that mean for your well visits? For your appointments with your doctors? For prophylactic decisions that you might make? Or for even survey and treatment and watchful waiting and things that you can do because that’s really frustrating for some people.
Dr. Ball: Sure. That’s where the family history piece is important because if someone has positive family history for heart disease or diabetes, that would be where we’re a little bit more aggressive with lifestyle changes and earlier testing. So I know people do get frustrated that they may have a genetically linked disease process. So it’s frustrating that they may do all of these lifestyle changes, but it’s still that they’re predisposed to heart disease. If we’re aware of family history and that they may be more likely to get diabetes at a young age, prevention is key with those folks. When you ask what to do, it would be the things we want everyone to do, but hopefully see us more frequently to encourage these which would be the healthy diet, physical activity. Obviously maintaining a healthy weight for everyone is important, but that especially is important for decreasing your chance or diabetes and heart disease. Not smoking is a huge one, which we council everyone on. If you're predisposed, even more important. Then checking with us. So if we know you’re at risk for heart disease and diabetes, we would be checking lab test results more frequent maybe than the average patient that’s not at risk.
Host: Wow, that was great information. Now, Dr. Ball, even some things that might seem a little less severe like arthritis—These things can really be passed down. I know I've got my mother’s hands. I can see that I'm going to have that arthritis in my hands already. Is there anything we can do about those kinds of things or are they inevitable?
Dr. Ball: Well, they're not inevitable if it’s a family history and we can prevent it. So diabetes is one that’s very specific to me that I would do the best I can to prevent it and treat early if possible. Things like arthritis, that would depend. Osteoarthritis versus rheumatoid arthritis where we know an autoimmune process, like rheumatoid, is more likely to be genetically linked than osteoporosis is wear and tear that most people have at a certain age. So if there was something like a rheumatoid arthritis or specific autoimmune processes, the patient would have a more likely chance of having that as well if the family did. In those cases, those are really important to treat early because it can stop the disease process from worsening. So it depends, again, with the family history which type of arthritis was it or was there autoimmune disease in the family outside of just rheumatoid?
Host: As we’re talking about these and before we wrap up, what about mental illness? Is that hereditary? And is there a screening tool if you know that a family member or has depression or a family member has bipolar? Are these kinds of things hereditary as well doctor?
Dr. Ball: Yes. We definitely see that the psychiatric illnesses—bipolar, schizophrenia, depression—tend to run in the family. Even alcoholism is more likely to run in families. We screen every patient we see regardless of them coming for a cold or a physical in my office for depression because it is so prevalent, but that’s what I love about family medicine. A lot of times we take care of families. So we may know the parent’s histories or siblings. If not, we should be at least asking the family history. Because if we screen for depression, we find that a lot in people that don’t have it in the family. If we know it’s in the family, we may be more in tuned to look for things like bipolar or treat earlier, be more aggressive with the treatment. So it is important, for sure, to know the family history. Especially things like depression and alcoholism to be aware of what the patient may be going through.
Host: Well, that’s really great advice. As we conclude Dr. Ball, how important is it to update your family history with your physician if a relative develops one of these diseases? So maybe your sister now gets breast cancer. Do you then go to your physician? While you're telling us that, please give us your best advice about the importance of knowing your family history and your family health history and relaying that information to your medical provider.
Dr. Ball: That’s a great question. My recommendation is to always update your family history with your physician. So any major changes, always bring that to them. Hopefully you’re seeing your family physician at least once a year. We would go through those questions again to make sure there aren’t updates to let us know about. Cancers are a big one. We always would want to know the cancers in the family to know if we should screen the patient sooner. Any heart disease, diabetes as you mentioned, mental illness. So even if it seems like something you aren’t sure we would want to know, you can tell us and then we would be able to talk about if it’s something that changes screening for you. Regardless, we always want to know the history. Then we would, like I said, talk with the patient to see if something should be done sooner than the average task force guidelines.
Host: Great information, Dr. Ball. It’s so important that patients hear this because, as you said, for certain diseases, there is an inherited trait and they should know so that they can look to prevention or look to lifestyle or even work with their physician on things that they can do and certainly keep a watch on it. Thank you so much for joining us today. That concludes this episode of BayCare Healthchat. Please visit our website at baycare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts for more health tips and updates, please follow us on your social channels and share this show with your friends and family so we can all learn from the experts at BayCare together. I'm Melanie Cole.
Family History and Your Health
Melanie Cole, MS (Host): Welcome. Today we’re talking about family history and your health. It’s a very important topic. You need to know what your family health history is so that you can be your own best health advocate. My guest is Dr. Lisa Ball. She’s a family medicine physician at BayCare. Dr. Ball, thank you so much for joining us. What role does inherited trait play in developing cancer and heart disease? How prominent is genetics in development of some of these diseases?
Lisa Ball, DO (Guest): Well, it can be very prominent depending on which cancer we’re talking about or which disease process we’re talking about. So family history is important in itself to know the patients, their lifestyle, what they grew up with, but also important because they may need screens for certain cancers earlier. Or if they have a predisposition for heart disease or diabetes, we would want to know that family history.
Host: So then what is important to know? What information do you want patients to know about family history of disease? What questions should they be asking older relatives and even cousins?
Dr. Ball: Right. So a lot of people want to know which family we’re even referring to. So the most important with family history would be your immediate family members. That would be your parents, your brothers, sisters, or your children. So any cancers with them is definitely very important. But we also want to know with grandparents, aunts, uncles, nieces, nephews. If there’s anything significant with them, we ask that as well. So when you speak with your family, you would want to ask for sure with any cancers with anybody. What age they may have been diagnosed, what cancer it was. If they passed away, what age they were when they died. Then the cause of death. It may not always be the cancer that was the cause of death.
Host: Well, that’s really a good point. Dr. Ball, how important is the age of onset of a particular condition? If a family history of heart disease or stroke occurred before the 1940s, for example, when medical care may have been a contributing factor or inaccessible, how important are those sorts of things as far as that genetic trait?
Dr. Ball: That’s still incredibly important, especially with early heart disease, because there are genetically linked factors that can cause heart disease despite the fact that the parent smoked, or they were inactive. There are for sure heart disease processes that can affect the patient if the parents died at a young age. So heart disease would be a big one if they had an early age at onset. Additionally, a big one would be any cancer at a young age, specifically colon cancer. If your immediate family member is diagnosed with colon cancer, we actually screen the patient 10 years prior to the age of their diagnosis. So the typical screening age for colon cancer is 50. Let’s say if your parent was diagnosed at 45, we would screen the patient at 35.
Host: Well then if you find these things out and you find out that someone in your family had colon cancer at a younger age, when is it that you start thinking about genetic counselling? What can you expect? How can you plan for even a pregnancy if you find out that these things are risk? What do you want them to know about when and why someone might be referred for genetics counselling?
Dr. Ball: Right. So if we have family history of genetic markers then we would refer to the patient for genetic counselling and testing for themselves. So a big one that patients ask about and is very common is the BRCA testing. That is the one that we know is genetically linked to cause breast cancers, pancreatic cancers, and a few others. So typically the patient would be aware that their immediate family member had a BRCA gene. If that happened, we would refer for genetic counselling and testing for the patient. When you ask specifically about their concerns—if it’s a female—for getting pregnant and their risk for things like that at a young age, that’s what the counselor would speak to them about.
Host: So let’s talk about some specific conditions. Colon cancer, for example. Some of them, as you said, if you have a genetic predisposition then you might need to be screened a little bit earlier. Tell us about colon cancer.
Dr. Ball: Right. So there are a few methods that—We follow the United States Preventative Task Force. So we can just say Task Force when we speak about it. We follow typically the Task Force guidelines with cancer screening. The typical one, still, is a colonoscopy. That’s still the gold standard. That would be at age 50 and every 10 years if normal for an individual that’s not at high risk. But if an immediate family member has colon cancer, whatever age they were diagnosed we would screen the patient 10 years prior. In those settings, because the family member had colon cancer, the patient would be offered and hopefully choose to do the colonoscopy as their screening because that would be a better screening method for them as opposed to someone who’s low risk and can do stool testing and other options for screening.
Host: Well, we’ve already mentioned breast cancer and the BRCA mutation. This is a big one. There are certain cultures that are more at risk. I mean there’s a lot that goes into this and now we’re finding out the risk for ovarian and, as you said, pancreatic. What do you want us to know about the BRCA mutation and breast cancer and family history of breast cancer and when we should be looking to get screened if there’s this risk?
Dr. Ball: Right. So breast cancer screening actually was kind of a controversy a few years ago because the task force recommends mammogram screening in age 50 to 74. I don’t know if the listeners remember. Typically 40 and above is recommended in other guidelines. So that became kind of a controversy of should we wait until 50, but really that’s where family history comes in. It is important to consider earlier testing based on the patient’s family history. So if the family member had a known BRCA positive test result, the patient should be tested for that. There are difficult times to get insurance to cover BRCA testing. If a patient doesn’t know a family member had a BRCA gene, then we can try to ask them questions to see if they're still at risk, which would be things like cancer in both breasts in the family member or breast cancer in the male relative or certain Ashkenazi-Jewish, which you mentioned certain cultures. So there are other ways to screen despite not knowing the family member’s BRCA test results. In those high risk individuals, we would want to screen earlier than 50.
Host: As we’re talking about all of these Dr. Ball, and one of the biggest questions is what do you do with that information? If you find out that you have familial hypercholesterolemia or heart disease or any of these things, what does that mean for your well visits? For your appointments with your doctors? For prophylactic decisions that you might make? Or for even survey and treatment and watchful waiting and things that you can do because that’s really frustrating for some people.
Dr. Ball: Sure. That’s where the family history piece is important because if someone has positive family history for heart disease or diabetes, that would be where we’re a little bit more aggressive with lifestyle changes and earlier testing. So I know people do get frustrated that they may have a genetically linked disease process. So it’s frustrating that they may do all of these lifestyle changes, but it’s still that they’re predisposed to heart disease. If we’re aware of family history and that they may be more likely to get diabetes at a young age, prevention is key with those folks. When you ask what to do, it would be the things we want everyone to do, but hopefully see us more frequently to encourage these which would be the healthy diet, physical activity. Obviously maintaining a healthy weight for everyone is important, but that especially is important for decreasing your chance or diabetes and heart disease. Not smoking is a huge one, which we council everyone on. If you're predisposed, even more important. Then checking with us. So if we know you’re at risk for heart disease and diabetes, we would be checking lab test results more frequent maybe than the average patient that’s not at risk.
Host: Wow, that was great information. Now, Dr. Ball, even some things that might seem a little less severe like arthritis—These things can really be passed down. I know I've got my mother’s hands. I can see that I'm going to have that arthritis in my hands already. Is there anything we can do about those kinds of things or are they inevitable?
Dr. Ball: Well, they're not inevitable if it’s a family history and we can prevent it. So diabetes is one that’s very specific to me that I would do the best I can to prevent it and treat early if possible. Things like arthritis, that would depend. Osteoarthritis versus rheumatoid arthritis where we know an autoimmune process, like rheumatoid, is more likely to be genetically linked than osteoporosis is wear and tear that most people have at a certain age. So if there was something like a rheumatoid arthritis or specific autoimmune processes, the patient would have a more likely chance of having that as well if the family did. In those cases, those are really important to treat early because it can stop the disease process from worsening. So it depends, again, with the family history which type of arthritis was it or was there autoimmune disease in the family outside of just rheumatoid?
Host: As we’re talking about these and before we wrap up, what about mental illness? Is that hereditary? And is there a screening tool if you know that a family member or has depression or a family member has bipolar? Are these kinds of things hereditary as well doctor?
Dr. Ball: Yes. We definitely see that the psychiatric illnesses—bipolar, schizophrenia, depression—tend to run in the family. Even alcoholism is more likely to run in families. We screen every patient we see regardless of them coming for a cold or a physical in my office for depression because it is so prevalent, but that’s what I love about family medicine. A lot of times we take care of families. So we may know the parent’s histories or siblings. If not, we should be at least asking the family history. Because if we screen for depression, we find that a lot in people that don’t have it in the family. If we know it’s in the family, we may be more in tuned to look for things like bipolar or treat earlier, be more aggressive with the treatment. So it is important, for sure, to know the family history. Especially things like depression and alcoholism to be aware of what the patient may be going through.
Host: Well, that’s really great advice. As we conclude Dr. Ball, how important is it to update your family history with your physician if a relative develops one of these diseases? So maybe your sister now gets breast cancer. Do you then go to your physician? While you're telling us that, please give us your best advice about the importance of knowing your family history and your family health history and relaying that information to your medical provider.
Dr. Ball: That’s a great question. My recommendation is to always update your family history with your physician. So any major changes, always bring that to them. Hopefully you’re seeing your family physician at least once a year. We would go through those questions again to make sure there aren’t updates to let us know about. Cancers are a big one. We always would want to know the cancers in the family to know if we should screen the patient sooner. Any heart disease, diabetes as you mentioned, mental illness. So even if it seems like something you aren’t sure we would want to know, you can tell us and then we would be able to talk about if it’s something that changes screening for you. Regardless, we always want to know the history. Then we would, like I said, talk with the patient to see if something should be done sooner than the average task force guidelines.
Host: Great information, Dr. Ball. It’s so important that patients hear this because, as you said, for certain diseases, there is an inherited trait and they should know so that they can look to prevention or look to lifestyle or even work with their physician on things that they can do and certainly keep a watch on it. Thank you so much for joining us today. That concludes this episode of BayCare Healthchat. Please visit our website at baycare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts for more health tips and updates, please follow us on your social channels and share this show with your friends and family so we can all learn from the experts at BayCare together. I'm Melanie Cole.