Even though you can't change your genetics, it's still very important to know your family's medical history. Knowing your family's medical history can help you take necessary steps to prevent and reduce your risk of health complications or disease.
Ruth Van Gerpen, MS, RN, shares the importance of knowing your medical history, and how knowing this, might help you prevent the chance of developing health problems later in life.
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For Your Health: The Importance of Knowing Your Family Medical History
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Learn more about Ruth Van Gerpen
Ruth Van Gerpen, RN, Bryan oncology clinical nurse specialist
Ruth Van Gerpen is an oncology clinical nurse specialist at Bryan.Learn more about Ruth Van Gerpen
Transcription:
For Your Health: The Importance of Knowing Your Family Medical History
Melanie Cole (Host): Even though you can't change your genetics, it's still very important to know your family's medical history. Knowing your family history can help you take the necessary steps to prevent and reduce your risk of health complications long-term. My guest today is Ruth Van Gerpen. She's a Bryan Oncology Nurse Navigator. Welcome to the show, Ruth. So, why is it so important to know family history for someone?
Ruth Van Gerpen (Guest): Well, one of the things that's important is your family history really can give you a good idea, especially, when it comes to medical care -- are there any medical conditions that happen to run in the family? You know, in my world, I guess, especially because I do a lot with individuals that have a family history or a personal history of cancer, we know that that can make a huge difference as far as looking at sometimes options, looking at things in the area of prevention, or some things that really are important to know when it comes to related to screening or trying to make changes in your own health, and especially in what you do to take care of yourself.
Melanie: What do you think is the most important information that people should know about their medical family history?
Ruth: Well as far as the medical family history, what are some of the things that they need to know? One is where your ancestors came from, and that probably sounds kind of crazy, but there are some genetic conditions, especially when it comes to cancer, that are more prevalent in certain ancestral origins, such as in the Ashkenazi Jews from Eastern Europe, is there is a higher risk in that population or those that have ancestors related to certain types of cancers. So, finding out your ancestry is important. Another is that you want to know your blood relatives, know who they are in your family. Not everybody even has that idea as far as first degree relatives: your parents, your brothers, sisters. Second degree relatives, which includes your aunts, your uncles, your grandparents, any nieces or nephews. It's important to know what age they died, and maybe what they died from, but you also want to know as far as health conditions go. Some of these may be some chronic types of conditions; do they have heart disease, for instance? Have they had a history of diabetes, but again when it comes to cancer, we also know that knowing what type of cancer the individual had is important, but what has become even more important is the age at which they were diagnosed. It's also important for the individual because that will help determine at what age certain types of screening tests should begin.
Melanie: So you brought up age because that is becoming more and more important, and let's talk about cancer and/or heart disease because people say, "Oh well, I had a 90-year old uncle who came up with heart disease or got lymphoma or leukemia." What age do you kind of say to yourself, well if they got it in their late 80's -- it's not considered familial risk? Is there an age?
Ruth: Well, there is in many cases, especially when we look at cancer or even some other conditions. The younger the person is when these things start and then typically we have 50 as the cutoff -- if somebody's been diagnosed with cancer such as breast cancer or colon cancer -- are probably two of the main ones -- prostate cancer is another one, and even some lung cancers at a younger age if this has happened younger than the age of 50, that increases the concern. We kind of call it a red flag. It kind of for me, it sends a red flag up the pole that says, you know, I need to know a little bit more about this family history because it may indicate in those individuals that there could possibly be an inherited risk. Something that has been given to them by a parent, and, therefore, we need to do different screenings and in some cases, preventative types of measures, and the same thing, in all honesty, would be true with heart disease as well. Fifty is kind of that cut-off area.
Melanie: And how late -- how old does someone have to be before you say it's really not something we're going concern ourselves with?
Ruth: Oh, you know, that's an interesting question because as we get older, but typically, you know, it's kind of around the age of even 65 to 70 as the age gets higher, and as we get closer to 70 or older, it is not felt to be as much of an inherited risk. It is sometimes more familial, and in many cases, it sometimes is an environmental risk. Things that are lifestyle-related, things that have just been from kind of chronic exposures and especially when we look at things such as lung cancer. Lung cancer is -- we can see it at any age -- but those as they get older often it's due to just ongoing exposure, for instance, to second-hand smoke. Sometimes it can be due to obviously, again, years of smoking. We may also just see from prolonged radon exposure environmentally that could pose a risk to an individual.
Melanie: And as the times change, Ruth, then, we can also look to the fact of suppose you had a grandfather who back in the '20's or the '30's had some kind of a heart issue or cancer, even though it was so long ago, and treatments were so different, do we still look at that as a risk?
Ruth: What it needs to be done is looked at the whole history. If it's a grandfather, who is a second-degree relative, if neither one of my parents have any issues, say, their blood pressure is fine; they remain very active; weight is controlled, no issues cholesterol-wise. No other indication that there's a concern related to the heart, the influence of my grandfather's situation that he may have had or the treatment that may have been required may really become less relevant, but it's still important to put in the overall family picture -- the overall family history -- and that's when those conversations with the individual's primary care provider is so important is that they look at it as a whole. One individual in the family may not be a big deal, but if it is something that we see in multiple generations, even two or three generations or a couple different people in the same generation, that sometimes again can raise a little bit more concern that the primary care provider may say, "You know what, I think we need to probably check out your heart. Let's get a stress test done. Let's get an echocardiogram done." It really is going to depend on what the family member may have presented with, what their problems may have been, as well as, in all honesty, their overall health can sometimes play a role.
Melanie: And you mentioned screening before and how family history can play a role in the types of screening, for example, colonoscopy, which typically would be done at age 50, unless you had a history of colon cancer in your family. So, who is it you discuss this with your healthcare provider and what do you want them to know, the listeners, about screenings and looking into these kinds of questions, so that they can get the proper screenings at the proper time?
Ruth: You really hit it on the head as far as I'm concerned. Colon cancer is one of -- it's an excellent example. You know, the recommendations are for individuals that at an average risk to begin looking at things at the age of 50, but if somebody had a parent or a brother or a sister, for instance, that had been diagnosed with colon cancer, say at the age of 45, or even if they had had a screening colonoscopy done at the age of 50 and was found to have some abnormal polyps, the type of growths in the colon that can lead to the development of a cancer, if those had been found, with a parent, their children would need to begin screening at an earlier age than the age of 50. If it's cancer, we usually say 10 years prior to that. With polyps, again, that's going to depend on the number and the exact type of a polyp, but that's important information to have. Whether you begin screening at the age of 40 or 45, or you start at the age of 50, so what a person needs to ask their provider is to say, "You know, here's what I know about my family. You know, I just found my dad -- he's 55. He ended up having a colonoscopy, took him a few years, but he got it done, and they found three polyps. What does that mean for me? Do I need to start doing that sooner? At what age? At what age do I need to visit with you again or you can have in my record to make sure that I get that done." Same thing is true with women and even men, but more so women with a family history of breast cancer. If there has been breast cancer; somebody has been with diagnosed that or even ovarian cancer at any age, but breast cancer is again -- it's 10 years before -- is when doing mammography needs to begin and so the age really is important to help identify when we start screening. For men with prostate cancer, if they have a grandfather, an uncle, a brother, that's been diagnosed at an age of younger than 50 or even at 50, the family members should start 10 years before that and start looking at having a discussion with their provider about doing prostate-specific antigen blood tests or a digital rectal exam to start looking and identifying where their risk is for prostate cancer as well.
Melanie: And so where would genetic testing fit into this picture you mentioned for us to cancer? The BRCA gene has been in the media quite a bit lately, and we're finding out that that same gene can be responsible for other types of cancers as well, or let you know that you're at higher risk. Who would you recommend get a genetic test and then what are they supposed to do with that information?
Ruth: Well, there are a few key things to look at when you put your family history together. One is, is if you have a family member, and this would be especially a first or a second degree relative, so a parent, a brother or a sister, an aunt, uncle, grandparent who's been diagnosed with cancer before the age of 50, that would be a reason to say, "Maybe I need to look at my family history a little bit further and see if this is something that I need to be aware of." So, number one is diagnosed with cancer before the age of 50. Second one is if there's a family member who has had two or more different cancers. Now, sometimes they may not be related at all, but a couple of examples. One is if somebody has had colon cancer as well as endometrial, or cancer of the uterus. Those are linked together to a certain type of an inherited type of a risk. A woman who has had both breast cancer and ovarian cancer, a woman who has had breast cancer two different times, and that are different cancers, not one that has recurred after an initial diagnosis of cancer -- those are situations, again, that raise the concern that there may be a need to have some genetic testing or at least look deeper at the family history, and another one then is if there are two or more members within the family, first-degree, second-degree within, you know, either the mother's side of the family or the father's side of the family, that have had the same type of cancer. So, for instance, a mother and her sister or a mother and grandmother that have both had breast cancer or the same thing with ovarian cancer, or two individuals with colon cancer, prostate cancer, uterine cancer. Those again are concerns; what we call the red flags as far as that there could be the need to look at genetic testing.
Melanie: So wrap it up for us, Ruth. With your best advice for listeners and their loved ones about knowing their own family medical history -- the importance of being honest with both themselves and their healthcare providers as to what’s going on in their family, to give themselves the best chance at prevention or recognizing some of these red flags.
Ruth: The most important things. One is know your family history. Find it out. Ask the questions. The second is if you have some of those red flags, talk to your primary care provider about seeing a genetic counselor. They're available in many communities, and, often, you can see them at no cost. Third is to start taking steps to reduce your risk. For instance, know when you should get your screening done, and don't put it off. Do it. Also, we know that things that you can do to help reduce your risk is, in general, is to eat healthy. Stay active, have regular exercise, quit smoking if you are smoking. All of those are going to benefit from a standpoint of heart disease but also from a risk of cancer.
Melanie: Thank you so much, Ruth, for being with us today. If you have questions about genetic testing, talk to your doctor. If you do not have a healthcare provider, you can find one at bryanHealth.org/doctors. That's bryanHealth.org/doctors. This is Melanie Cole for Bryan Health Radio. Thanks for listening.
For Your Health: The Importance of Knowing Your Family Medical History
Melanie Cole (Host): Even though you can't change your genetics, it's still very important to know your family's medical history. Knowing your family history can help you take the necessary steps to prevent and reduce your risk of health complications long-term. My guest today is Ruth Van Gerpen. She's a Bryan Oncology Nurse Navigator. Welcome to the show, Ruth. So, why is it so important to know family history for someone?
Ruth Van Gerpen (Guest): Well, one of the things that's important is your family history really can give you a good idea, especially, when it comes to medical care -- are there any medical conditions that happen to run in the family? You know, in my world, I guess, especially because I do a lot with individuals that have a family history or a personal history of cancer, we know that that can make a huge difference as far as looking at sometimes options, looking at things in the area of prevention, or some things that really are important to know when it comes to related to screening or trying to make changes in your own health, and especially in what you do to take care of yourself.
Melanie: What do you think is the most important information that people should know about their medical family history?
Ruth: Well as far as the medical family history, what are some of the things that they need to know? One is where your ancestors came from, and that probably sounds kind of crazy, but there are some genetic conditions, especially when it comes to cancer, that are more prevalent in certain ancestral origins, such as in the Ashkenazi Jews from Eastern Europe, is there is a higher risk in that population or those that have ancestors related to certain types of cancers. So, finding out your ancestry is important. Another is that you want to know your blood relatives, know who they are in your family. Not everybody even has that idea as far as first degree relatives: your parents, your brothers, sisters. Second degree relatives, which includes your aunts, your uncles, your grandparents, any nieces or nephews. It's important to know what age they died, and maybe what they died from, but you also want to know as far as health conditions go. Some of these may be some chronic types of conditions; do they have heart disease, for instance? Have they had a history of diabetes, but again when it comes to cancer, we also know that knowing what type of cancer the individual had is important, but what has become even more important is the age at which they were diagnosed. It's also important for the individual because that will help determine at what age certain types of screening tests should begin.
Melanie: So you brought up age because that is becoming more and more important, and let's talk about cancer and/or heart disease because people say, "Oh well, I had a 90-year old uncle who came up with heart disease or got lymphoma or leukemia." What age do you kind of say to yourself, well if they got it in their late 80's -- it's not considered familial risk? Is there an age?
Ruth: Well, there is in many cases, especially when we look at cancer or even some other conditions. The younger the person is when these things start and then typically we have 50 as the cutoff -- if somebody's been diagnosed with cancer such as breast cancer or colon cancer -- are probably two of the main ones -- prostate cancer is another one, and even some lung cancers at a younger age if this has happened younger than the age of 50, that increases the concern. We kind of call it a red flag. It kind of for me, it sends a red flag up the pole that says, you know, I need to know a little bit more about this family history because it may indicate in those individuals that there could possibly be an inherited risk. Something that has been given to them by a parent, and, therefore, we need to do different screenings and in some cases, preventative types of measures, and the same thing, in all honesty, would be true with heart disease as well. Fifty is kind of that cut-off area.
Melanie: And how late -- how old does someone have to be before you say it's really not something we're going concern ourselves with?
Ruth: Oh, you know, that's an interesting question because as we get older, but typically, you know, it's kind of around the age of even 65 to 70 as the age gets higher, and as we get closer to 70 or older, it is not felt to be as much of an inherited risk. It is sometimes more familial, and in many cases, it sometimes is an environmental risk. Things that are lifestyle-related, things that have just been from kind of chronic exposures and especially when we look at things such as lung cancer. Lung cancer is -- we can see it at any age -- but those as they get older often it's due to just ongoing exposure, for instance, to second-hand smoke. Sometimes it can be due to obviously, again, years of smoking. We may also just see from prolonged radon exposure environmentally that could pose a risk to an individual.
Melanie: And as the times change, Ruth, then, we can also look to the fact of suppose you had a grandfather who back in the '20's or the '30's had some kind of a heart issue or cancer, even though it was so long ago, and treatments were so different, do we still look at that as a risk?
Ruth: What it needs to be done is looked at the whole history. If it's a grandfather, who is a second-degree relative, if neither one of my parents have any issues, say, their blood pressure is fine; they remain very active; weight is controlled, no issues cholesterol-wise. No other indication that there's a concern related to the heart, the influence of my grandfather's situation that he may have had or the treatment that may have been required may really become less relevant, but it's still important to put in the overall family picture -- the overall family history -- and that's when those conversations with the individual's primary care provider is so important is that they look at it as a whole. One individual in the family may not be a big deal, but if it is something that we see in multiple generations, even two or three generations or a couple different people in the same generation, that sometimes again can raise a little bit more concern that the primary care provider may say, "You know what, I think we need to probably check out your heart. Let's get a stress test done. Let's get an echocardiogram done." It really is going to depend on what the family member may have presented with, what their problems may have been, as well as, in all honesty, their overall health can sometimes play a role.
Melanie: And you mentioned screening before and how family history can play a role in the types of screening, for example, colonoscopy, which typically would be done at age 50, unless you had a history of colon cancer in your family. So, who is it you discuss this with your healthcare provider and what do you want them to know, the listeners, about screenings and looking into these kinds of questions, so that they can get the proper screenings at the proper time?
Ruth: You really hit it on the head as far as I'm concerned. Colon cancer is one of -- it's an excellent example. You know, the recommendations are for individuals that at an average risk to begin looking at things at the age of 50, but if somebody had a parent or a brother or a sister, for instance, that had been diagnosed with colon cancer, say at the age of 45, or even if they had had a screening colonoscopy done at the age of 50 and was found to have some abnormal polyps, the type of growths in the colon that can lead to the development of a cancer, if those had been found, with a parent, their children would need to begin screening at an earlier age than the age of 50. If it's cancer, we usually say 10 years prior to that. With polyps, again, that's going to depend on the number and the exact type of a polyp, but that's important information to have. Whether you begin screening at the age of 40 or 45, or you start at the age of 50, so what a person needs to ask their provider is to say, "You know, here's what I know about my family. You know, I just found my dad -- he's 55. He ended up having a colonoscopy, took him a few years, but he got it done, and they found three polyps. What does that mean for me? Do I need to start doing that sooner? At what age? At what age do I need to visit with you again or you can have in my record to make sure that I get that done." Same thing is true with women and even men, but more so women with a family history of breast cancer. If there has been breast cancer; somebody has been with diagnosed that or even ovarian cancer at any age, but breast cancer is again -- it's 10 years before -- is when doing mammography needs to begin and so the age really is important to help identify when we start screening. For men with prostate cancer, if they have a grandfather, an uncle, a brother, that's been diagnosed at an age of younger than 50 or even at 50, the family members should start 10 years before that and start looking at having a discussion with their provider about doing prostate-specific antigen blood tests or a digital rectal exam to start looking and identifying where their risk is for prostate cancer as well.
Melanie: And so where would genetic testing fit into this picture you mentioned for us to cancer? The BRCA gene has been in the media quite a bit lately, and we're finding out that that same gene can be responsible for other types of cancers as well, or let you know that you're at higher risk. Who would you recommend get a genetic test and then what are they supposed to do with that information?
Ruth: Well, there are a few key things to look at when you put your family history together. One is, is if you have a family member, and this would be especially a first or a second degree relative, so a parent, a brother or a sister, an aunt, uncle, grandparent who's been diagnosed with cancer before the age of 50, that would be a reason to say, "Maybe I need to look at my family history a little bit further and see if this is something that I need to be aware of." So, number one is diagnosed with cancer before the age of 50. Second one is if there's a family member who has had two or more different cancers. Now, sometimes they may not be related at all, but a couple of examples. One is if somebody has had colon cancer as well as endometrial, or cancer of the uterus. Those are linked together to a certain type of an inherited type of a risk. A woman who has had both breast cancer and ovarian cancer, a woman who has had breast cancer two different times, and that are different cancers, not one that has recurred after an initial diagnosis of cancer -- those are situations, again, that raise the concern that there may be a need to have some genetic testing or at least look deeper at the family history, and another one then is if there are two or more members within the family, first-degree, second-degree within, you know, either the mother's side of the family or the father's side of the family, that have had the same type of cancer. So, for instance, a mother and her sister or a mother and grandmother that have both had breast cancer or the same thing with ovarian cancer, or two individuals with colon cancer, prostate cancer, uterine cancer. Those again are concerns; what we call the red flags as far as that there could be the need to look at genetic testing.
Melanie: So wrap it up for us, Ruth. With your best advice for listeners and their loved ones about knowing their own family medical history -- the importance of being honest with both themselves and their healthcare providers as to what’s going on in their family, to give themselves the best chance at prevention or recognizing some of these red flags.
Ruth: The most important things. One is know your family history. Find it out. Ask the questions. The second is if you have some of those red flags, talk to your primary care provider about seeing a genetic counselor. They're available in many communities, and, often, you can see them at no cost. Third is to start taking steps to reduce your risk. For instance, know when you should get your screening done, and don't put it off. Do it. Also, we know that things that you can do to help reduce your risk is, in general, is to eat healthy. Stay active, have regular exercise, quit smoking if you are smoking. All of those are going to benefit from a standpoint of heart disease but also from a risk of cancer.
Melanie: Thank you so much, Ruth, for being with us today. If you have questions about genetic testing, talk to your doctor. If you do not have a healthcare provider, you can find one at bryanHealth.org/doctors. That's bryanHealth.org/doctors. This is Melanie Cole for Bryan Health Radio. Thanks for listening.