[2021-06-07] Health history
A friend recently wrote to me, saying: "Health battles are so personal and so universal simultaneously." As often happens, a statement that resonates with me keeps rattling around my brain. Such was the case with this comment, which I've repeated several times in the past few days.
I have chosen to share my personal health story, knowing that many of the themes I cover are universal—even those not strictly about cancer. For example, my post on Best days struck a chord with many people, some seeing walking away as a path to better mental health for themselves.
Returning to my friend's statement, I would add a third category: familial. In other words, health battles are personal (experienced by the individual), universal (experienced by all of us, though the specifics vary), and often familial (frequently experienced by multiple family members).
There was a time when family doctors conducted annual checkups with their patients, asking about family history of diseases and health conditions, which they used to provide advice and to determine which tests to order. Such checkups and questions seem less common now, but that doesn't lessen our responsibility to know about our family's health history.
When I was referred to genetic testing because a gene change was found in my cancer tumours, I completed a form identifying incidents of cancer and other diseases, age of diagnosis and cause of death (where applicable) among my parents, grandparents, siblings, children, aunts, uncles and cousins. I was lucky that my mom was alive and sharp enough to help me answer all the questions in the form. It took us several hours to fill it out, but it was well worth the time. It was the first time I had written down my health history.
Based on the report I provided about my extended family, my genetic counselor guessed that the gene change would be found in all my cells and not just my tumours. She was right. That meant that I had inherited the faulty gene from one of my parents and that my mom, siblings and children have a 50-50 chance of also having the gene change.
This makes my health battle with cancer not just personal and universal, but also familial. My family members now have access to genetic testing, which can provide lifesaving information they can use to reduce their risks of developing cancer themselves or finding it at a late stage. My misfortune may prevent their experiencing the same misfortune in the future.
Such was the case for a friend I spoke to today. She shared that her mother and aunts had had breast cancer. When it was confirmed that her mother had the BRCA2 gene change, my friend underwent genetic testing. After learning that she, too, was BRCA2 positive, she opted for surgery to remove her breast tissue and ovaries. Not only did that greatly reduce her risk of developing breast cancer and ovarian cancer, but it also eliminated the stress of wondering whether she would be diagnosed with either disease.
The universal lesson of my story and my friend's is that we can all benefit from knowing our health history and using the information about diseases and health conditions that run in our families to reduce our risks.
The U.S. Centers for Disease Control and Prevention (CDC) has an excellent webpage on this topic: Knowing is Not Enough—Act on Your Family Health History. It begins:
Has your mother or sister had breast cancer? Does your mother, father, sister, or brother have diabetes? Did your mother, father, brother, or sister have colorectal (colon) cancer before age 50? If you answered "yes," you are more likely to get the same disease as your parent or sibling and should consider earlier screening. Talk to your doctor about when to start screening and what other steps to take to prevent the disease or find it early. Finding disease early can often mean better health in the long run.
The CDC points out that just because someone in your family has a disease or health condition, it does not mean that you will inevitably develop the same illness. But knowledge is power—if you act on it. The CDC recommends that you collect your family health history as an important first step in taking charge of your health. It states:
Whether you know a lot about your family health history or only a little, take time to talk to your family about their health histories.... It might not be easy. Your family members might not be used to talking about their diseases or might not want to talk. But starting the conversation is important. Remember, you’re asking not just for your own health, but for the health of everyone in your family.
To build your family history, the CDC recommends that you talk to your relatives about what health conditions and chronic diseases they have now or had in the past as well as their age when they were diagnosed. For example, you could ask: "Do you have any chronic diseases, such as heart disease or diabetes, or health conditions, such as high blood pressure or high cholesterol?" Write down the answers and update your family health history whenever you get new information. Share the information with your health care provider, even if it's not complete. The CDC says: "Family health history information, even if incomplete, can help your doctor decide which screening tests you need and when those tests should start."
The CDC's final recommendation is to let your family members know the information you have gathered.
If you have a medical condition, such as cancer, heart disease, or diabetes, be sure to let your family members know about your diagnosis. If you have had genetic testing done, share your results with your family members. If you are one of the older members of your family, you may know more about diseases and health conditions in your family, especially in relatives who are no longer living. Be sure to share this information with your younger relatives so that you may all benefit from knowing this family health history information.
The CDC webpage provides guidance on how you can take action if one or more of your family members has been diagnosed with a specific disease or health condition, such as heart disease or osteoporosis.
I acknowledge the difficulty in having conversations with family members about health matters, but your willingness to share could set a trend. You could prevent a relative from going through the same ordeal as you and, if your family members reciprocate, you could avoid experiencing adversity that they faced.
