The fourth Thursday in November brings to mind family feasts, turkey trots, and pumpkin pies—but another special day actually falls on the same date: National Family Health History Day.
Deliberately scheduled on a day when you’re traditionally with family, the holiday seeks to raise awareness for the importance of knowing health information about those who are genetically related to you.
“In some instances, such as family histories of cancers or enlarged hearts, knowing about this risk before a person develops the disorder is very important so that appropriate tests can be ordered to catch problems early,” says Amy Shealy, genetic counselor in Cleveland Clinic’s Center for Personalized Genetic Healthcare. Gathering this information this Thanksgiving can seem daunting, but knowing a few key things to ask—and how—can help guide the process.
What diseases run in families?
“There are hundreds of conditions that could run through families,” says Shealy. “Some are very strongly hereditary such as Hereditary Breast and Ovarian Cancer Syndrome, certain forms of colon cancer, cystic fibrosis, and sickle cell disease.”
Some conditions to seek family health history about include:
- Cancers: The age at which a person might need to start screening for colon cancer or breast cancer can depend on family history and personal risk.
- Diabetes, hypertension, high cholesterol, and heart attacks or stroke: These metabolic and cardiovascular conditions may be inherited, but multifactorial. Meaning, multiple factors have to “work together” to cause disease, says Shealy.
- Depression, anxiety, and addiction: Behavioral health can also have genetic determining factors and help in planning future health.
- Huntington disease and Alzheimer’s disease: Early onset of neurological conditions is particularly important in predicting genetic risks.
- Autoimmune disorders: Thyroid disease, lupus, arthritis, inflammatory bowel disease, and more can be hereditary.
How to find your family health history
Some families tend to have a “family historian,” which is a good place to start, says Shealy. Beyond that, the short answer is that you’re going to have to ask some questions.
Robert Pilarski, a licensed genetic counselor at Wexner Medical Center says, “Asking these questions is all for an important end. And the more we can normalize these conversations, the better.”
When to ask
Pilarski suggests starting to talk about family health histories sooner than later. As time goes on, family members may pass away and information may be lost. In a year when COVID-19 has many of us focused on our own health risks, it’s a highly relevant time to connect with family and work together to increase control over our health in a meaningful way, adds Anna Flattau, MD, Director of Strategic Development, Department of Family & Social Medicine at Montefiore Medical Center.
Pediatricians can start collecting this information for newborns and update the history with each visit as the child grows older. For new children, adolescent, or adult patients, providers should collect a comprehensive family medical history at the first visit. Providers can use support staff, written surveys, computer surveys, or interviews to obtain this information.
Who to ask
When seeking out family health history, include your parents, grandparents, siblings, aunts, uncles and children. “The people closest to you are probably the best indicator, but if you have two cousins who encounter the same disease, it might be a piece of information to pay attention to,” Pilarski adds.
How to ask
Keep in mind that some families will be more open than others and willing to discuss the topic at the dinner table, while some may prefer more private interactions, even via a letter or email in some cases, says Shealy.
- Strike a balance: Yes, you’re seeking out for your own genetic risk factors, but you’re also asking about personal health information from people who may have a lot of emotions about their own health history, so bear that in mind. “A lot of past suffering or fear is tied up in health issues,” Flattau says.
- Be transparent: Telling people that your doctor wanted you to ask some questions about family health history is a good way to remind people that it’s for an important cause and help it feel less like prying, says Pilarski.
- Explain why it’s important: Whether you’re trying to make sure that you stay healthy in the future so that you can care for your children or simply live a better, longer life, sharing why you’re seeking this information can provide context.
- Give people space: Be respectful of how much information family members are willing to share in the moment, and understand that they may need to come back to the subject.
- Consider your own reactions: It’s not uncommon to have traumatic memories of relatives and be afraid to think of the condition in your own life, notes Flattau. However, you can improve your own outcomes by talking about those risks with your primary care provider and making a plan.
What to ask
In addition to who you should ask, it’s important to know what to ask. Here is a good starting guide:
- What chronic illnesses have family members had, especially those that require medication, surgery, or ongoing management?
- Has anyone in the family had any types of cancers?
- Who has passed away, and what was their cause of death? Death records can help in the case of missing or forgotten information, says Pilarski.
- What was the age of diagnosis? Having an illness develop earlier in life implies a stronger risk than if the same illness occurs in older age, says Flattau.
How to keep records
Flattau recommends keeping track of family health histories with a family tree, which allows multiple people in the family to reference the same document with ease. The visual nature also helps providers see several generations at once and assess patterns as well as the degree of relationship. Finally, a family tree gives a sense of how large a family is, which helps to understand the frequency at which conditions have occurred.
The Centers for Disease Control and Prevention (CDC) and the U.S. Surgeon General offer some excellent resources for collecting and recording family medical histories. You can create a family health portrait using the Surgeon General’s website. Or use this form from the March of Dimes.
The bottom line—knowing your family health history is important
Family histories are an incredibly actionable way to improve your future health, so taking the time to compile one is an important task. “You can’t change your genetic risk—that’s already inside you—but you can use the information to prioritize for your own health,” Flattau says.