Health Alert

Rec­og­nize the risk of can­cer in your fam­ily

Health & Nutrition - - CONTENTS -

You may re­mem­ber sto­ries of your fa­ther’s mil­i­tary ser­vice and your mother’s home­town, but how much do you know about your fam­ily’s med­i­cal his­tory? In par­tic­u­lar, do you know whether any­one on your mom or dad’s side ever had can­cer? “Fam­ily his­tory can be one of the first lines of de­fense in pre­vent­ing can­cer,” says Dr Huma Q Rana, clin­i­cal di­rec­tor of the Cen­tre for Can­cer Ge­net­ics and Pre­ven­tion at Har­vard-af­fil­i­ated Dana-Far­ber Can­cer In­sti­tute. “If you can get a pic­ture of the pat­terns of can­cer on both sides of your fam­ily, you can screen for cer­tain can­cers more closely and ei­ther pre­vent them or catch them early.” And if you do get can­cer, your ge­netic her­itage might pro­vide clues to help your doc­tor choose tar­geted ther­a­pies to treat it.

All in the fam­ily

Your fam­ily’s can­cer his­tory should in­clude your first-de­gree rel­a­tives – fa­ther, mother, and sib­lings – as well as your sec­ond-de­gree rel­a­tives, if pos­si­ble – aunts, un­cles, and grand­par­ents. Note what type of can­cer oc­curred, the age at di­ag­no­sis, as well as the age at which the per­son died and the cause of death. The first-de­gree rel­a­tives tend to be the most cru­cial. “This is be­cause you share 50% of your DNA with them. A ge­netic sus­cep­ti­bil­ity to can­cer does not guar­an­tee that you will get can­cer, but you have a higher risk,” says Dr Rana. Life­style and en­vi­ron­men­tal fac­tors

also play a part in your can­cer risk as­sess­ment. For in­stance, if your fa­ther died of lung can­cer in his 80s and was a life­long smoker, the can­cer prob­a­bly did not re­flect a strong ge­netic trait. If you can pin­point a cer­tain hered­i­tary can­cer in your fam­ily, you may run the risk of de­vel­op­ing other types of can­cers as­so­ci­ated with it. For in­stance, 3% of peo­ple with colon can­cer have Lynch Syn­drome, an in­her­ited dis­or­der that also in­creases the risk of can­cers of the stom­ach, kid­ney, blad­der, skin, and (in women) uterus. Of course, a fam­ily med­i­cal his­tory can be dif­fi­cult to ob­tain. Fam­ily mem­bers can be es­tranged or not forth­com­ing about their his­tory of can­cer. And odds are your older rel­a­tives have passed away. Even if you can’t cre­ate a com­plete fam­ily can­cer his­tory, any med­i­cal in­for­ma­tion you can pro­vide your doc­tor is help­ful. “For in­stance, know­ing if fam­ily mem­bers have died of other causes and age at di­ag­no­sis or death can help build a fam­ily his­tory pro­file,” says Dr Rana.

Pass it along

Who has been di­ag­nosed with can­cer in your fam­ily af­fects not only you, but also your chil­dren. For ex­am­ple, if your mother died of breast or ovar­ian can­cer, which can some­times re­sult from a mu­ta­tion in the BRCA1 or BRCA2 genes, you might not worry about it your­self since th­ese are woman-spe­cific can­cers. But you may have in­her­ited a mu­ta­tion that is also as­so­ci­ated with the de­vel­op­ment of ag­gres­sive prostate can­cer, says Dr Rana. And even if you re­main can­cer­free, you could still pass along that mu­tated gene to your daugh­ter, which puts her at a higher risk for breast or ovar­ian can­cer. In fact, a 2011 study found that 24% of women with ovar­ian can­cer had an un­der­ly­ing mu­ta­tion. “That’s why it’s so im­por­tant to try to put to­gether as de­tailed a med­i­cal his­tory as pos­si­ble. It’s not just for you, but some­thing you can share with your chil­dren and grand­chil­dren,” says Dr Rana.

Ge­netic test­ing

Your fam­ily can­cer his­tory is only the first step. A ge­netic test can help clar­ify whether you have one or more spe­cific ge­netic mu­ta­tions. Ge­netic test­ing in­volves see­ing a ge­netic coun­sel­lor or other spe­cial­ist who as­sesses your fam­ily his­tory and ex­plains the risks and out­comes of test­ing, like anx­i­ety from in­con­clu­sive re­sults, or the need for closer can­cer sur­veil­lance if you have a mu­ta­tion. A sim­ple blood or saliva test looks for mu­ta­tions in a num­ber of genes re­lated to can­cer. You typ­i­cally get the re­sults in about four weeks. Years ago, ge­netic test­ing was ex­pen­sive, but it is now more af­ford­able and ac­ces­si­ble. Think you’re too old to worry about can­cer? Think again. Can­cer, like some rel­a­tives, can al­ways show up un­ex­pected. “You can get di­ag­nosed with can­cer late in life, so don’t think you are home free if you reach a cer­tain age can­cer-free,” says Dr Rana. “Know your fam­ily his­tory and talk to your doc­tors about your pos­si­ble risk and strate­gies for pre­ven­tion.”

Know­ing your fam­ily’s his­tory of can­cer can help you bet­ter as­sess your own risk. This sample fam­ily tree de­picts a fam­ily with a his­tory of ovar­ian, breast and prostate can­cer.

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