OPINION: I often have conversations with patients who are concerned that some disease or medical condition may “run in their family”.
Understandably, this can cause huge amounts of anxiety and stress – and not infrequently people will wait years before actually talking their concerns through with a health professional. What strikes me during these discussions is that many of the medical conditions that people worry about don’t actually “run in families” at all, and an understanding of that could have avoided many years of worry.
So here is my list of 10 common things you DO need to know about – this list is by no means exhaustive and doesn’t include more “obvious” hereditary conditions such as Huntingdon’s disease or cystic fibrosis.
I would recommend you ask your parents, or other close relatives, if they know whether or not any of these conditions have affected your family, and if so it is worth talking to your GP to see if there is anything you can do to alter your risk.
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Lastly, in general when looking at family health risks, the closer the relative affected, and the younger they were at the time, the higher the potential risk to you – so if your mother had a health problem in her 30s, it is likely to confer a greater risk to you than a great-uncle or cousin suffering from the same condition in their 90s.
This is always top of the list in terms of the anxiety it causes people, but interestingly only a few cancers actually pose a risk to relatives. Breast cancer certainly does, and if your mother, aunt, sister or grandmother have been affected, especially if they were younger and hadn’t yet been through the menopause, then it is worth talking to your doctor to see what risk, if any, you might have inherited.
Genetic specialists can look at risk pretty accurately, and advise you about the best course of action – usually the recommendation is to start screening with regular mammograms earlier than the funded 45 years with the breast screening programme.
Another common one is bowel cancer, and again age and the number of relatives affected is important in determining your own personal risk. Ovarian cancer – whilst not as common as the others, it is important to know about as routine screening isn’t offered to everyone, but can be arranged if you have a high risk in your family.
Occasionally, a genetic mutation can lead to an increased risk in both breast and ovarian cancers – very important to know about, and your GP will refer you for specialist advice if they are concerned this may be a possibility in your family.
The last one to mention here is prostate cancer – if you have a younger relative who has had prostate cancer (ie a brother, dad or uncle in their 40s or 50s) it is important to think about regular testing for yourself, perhaps from as early as 30 years old.
2. CARDIOVASCULAR DISEASE
This includes strokes and heart disease. There are many factors that contribute to the overall risk, including important lifestyle ones such as smoking, inactivity and poor diet. However, it is also possible to “inherit” a tendency to risk, specifically through high blood pressure and high cholesterol.
Your doctor can keep an eye on your blood pressure and cholesterol levels, and refer you to a cardiologist if your risk profile looks very worrying – there are medications available, such as aspirin, that can lower your risk dramatically if you fall into this group.
Premature “thinning” of your bones is something that tends to run in families, and an easy way to check if you are at increased risk is to ask for a bone density scan in your 40s. This is especially important for women.
4. EYE HEALTH
Cataracts, glaucoma and macular degeneration are leading causes of visual loss in New Zealand. Early detection is crucial to minimise the impact, so if they run in your family, regular eye checks are a good plan.
Some types of arthritis are related to “over-use” of joints, but others such as gout, rheumatoid and ankylosing spondylitis have a strong family tendency.
The good news is that although rare cases of dementia, including a small subgroup of Alzheimer’s, can be inherited, the majority of cases will be “sporadic” and won’t increase the risk of family members at all.
7. BLOOD CLOTS
If someone in your family has suffered a serious blood clot (deep vein thrombosis or pulmonary embolus) it is important you discuss this with your doctor. Abnormalities in the “clotting pathway” can be inherited, and are picked up by a simple blood test.
Lifestyle plays a big part in risk here, but diabetes can definitely be inherited as well, and the earlier diet modification and other treatment is instigated, the fewer the complications later on.
9. MENSTRUAL PROBLEMS
Not all issues with periods are passed on from mother to daughter, but a tendency to painful periods, endometriosis or polycystic ovaries can be.
10. AUTOIMMUNE CONDITIONS
This large group includes conditions like lupus, thyroid problems and coeliac disease. They tend to “cluster” in families, so if a relative is affected, check with your doctor about getting some testing done or keeping an eye out for telltale symptoms.
If you have read this list, and tick one or even more boxes, please don’t panic – risk is “multifactorial” and the part you get from your family is just a piece of the puzzle.
Getting a greater understanding of that risk, with extra testing if needed, and then modifying it where possible is the important bit.
Dr Cathy Stephenson is a GP and forensic medical examiner.