Beat your family history; even if breast cancer, heart disease, depression or obesity run in your family, there are preventive steps you can take now to improve your odds
By Stacey Colino, Jan, 2004
For better or worse, your parents' health history can predict your own: If your mom or dad has a serious condition like obesity, heart disease or cancer, your own risk is, of course, higher.
But how much higher? The truth is, what it means to have a family history can vary a lot depending on the disease. That's why it's important to not only know your medical background, but also to tease out how much hereditary factors influence your individual risk so you can identify the precautions to take to protect yourself while you're still healthy.
"Knowing your family history might save your life," says Theresa Frezzo, M.S., a genetic counselor and research coordinator at the Center for Genetic Medicine at Northwestern University in Chicago. "If you know that you have a family history of a particular disease, you can report that information to your health-care provider and take steps to modify your risk. With most adult-onset illnesses, your heritage is not your destiny. There are preventive measures you can take that can reduce your risk of following in your family member's footsteps."
But it's up to you to be proactive about your health care: A recent study led by Frezzo found that approximately 20 percent of patients in an internal-medicine clinic were at increased risk for diseases with genetic links--though this was not noted in their charts. (These family histories came to light because either the patients were asked for the information in a separate questionnaire or they were interviewed by a genetic-counseling intern.)
What follows is a detailed look at what it means to have a family history of some of the most common and most devastating conditions--and the best steps you can take to protect yourself.
* What a family history means If a first-degree relative such as your mother or sister had breast cancer at any point in her life, your risk is two to two-and-a-half times greater than it is for a woman without a family history, says Mary B. Daly, M.D., Ph.D., director of the Margaret Dyson Family Risk Assessment Program at the Fox Chase Cancer Center in Philadelphia. (High risk also can be defined as having a first- and a second-degree relative--a grandmother or an aunt--diagnosed with breast cancer at any time in their lives.) If a second-degree relative had breast cancer, your risk is one-and-a-half to two times higher than that of women in the general population. What this means is that while a woman in the general population has around a 12 percent risk of developing breast cancer in her lifetime, a woman whose mother was, say, diagnosed with postmenopausal breast cancer, or whose aunt and grandmother both developed breast cancer at any age, would have a 25 percent or higher risk. "These general risk syndromes can be transmitted on the maternal or paternal side," Daly says, so don't forget to consider your father's side of the family tree too when thinking about breast-cancer risk.
"About 30 percent of breast cancer is considered familial [meaning that someone in a family had it, but not necessarily due to a genetic mutation]," says Boris Pasche, M.D., Ph.D., F.A.C.P., director of the Northwestern University Cancer Genetics Program in Chicago. "Of these cases, about 5-10 percent are considered hereditary, meaning you see breast cancer in almost all generations because they're most likely to harbor mutations in BRCA 1 or 2 [the so-called breast-cancer genes]. The other 20-25 percent of familial breast cancers could be due to other genetic causes or to the interplay between genes and the environment--the mechanism isn't well understood at this point." (Keep in mind that mutations in BRCA 1 or 2 are more common among certain populations, such as those of Ashkenazi Jewish descent. The mutations affect about one in 800 people in the United States.)
The age of onset also plays a role: The genetic link is especially strong for premenopausal breast cancer. "If two or three [first- or second-degree relatives] developed breast cancer before the age of 40, that raises a red flag for one of these mutations," Daly says.
* How to beat your odds: Cut down on cocktails. Research has found that women who consume two or more alcoholic beverages per day have a significantly higher risk of breast cancer. But an analysis of more than 40 studies found that having one drink per day conferred only a 10 percent increased risk.
Maintain a healthy weight. Women who stick with a healthy weight throughout their lives have a lower risk of postmenopausal breast cancer, Daly says. Indeed, a recent study at the Fred Hutchinson Cancer Research Center in Seattle found that obese women (defined as having a body mass index over 31.1) had two-and-a-half times the risk of postmenopausal breast cancer as did women with a BMI under 22.6.
Increase folate and reduce animal-fat consumption. According to a recent report from the Nurses' Health Study, women with the highest folic-acid levels have a 27 percent lower risk of developing breast cancer than those with the lowest levels. (These protective effects are especially pronounced among women who drink alcohol regularly.) So load up on leafy greens, strawberries and fortified cereals--or pop a daily multivitamin and mineral supplement that contains 400 micrograms of folic acid. Be sure too to keep animal fat--especially from red meat and high-fat dairy products--to a minimum. The Nurses' Health Study II found that women who ate the most animal fat as young adults had a 33 percent higher risk of invasive breast cancer compared with those who ate the least.
Get a mammogram regularly if you're 40 or over. At this point, mammography is the best detection tool available for picking up small tumors. A woman with a family history of the disease should start screening five to 10 years before the earliest age at which breast cancer was diagnosed in her family, but not before age 25, Daly says.
Consider taking medication. For women who are carriers of a mutation in genes related to breast cancer (especially BRCA 2), taking tamoxifen, a hormone-based drug that's also used as a breast-cancer treatment, can reduce the risk of breast cancer by up to 50 percent, notes Boris Pasche. The downside: The drug can increase the risk of blood clots and uterine cancer; it also brings on premature menopause, complete with mood swings and loss of libido.
Talk to your doctor about getting a referral to a genetic specialist. If you have a strong family history of breast cancer and your ethnic background puts you in a high-risk group, you may want to pursue genetic testing. Women who have a BRCA 1 or 2 mutation not only have an 85 percent chance of getting breast cancer at some point in their lives but also an increased risk of ovarian cancer--a 44 percent chance for those with the BRCA 1 mutation and 27 percent for those with BRCA 2. "Removing the ovaries before the age of 40 in women who have these genes almost eliminates the risk of ovarian cancer, and reduces the risk of breast cancer by 50 percent," Pasche says. "And if a woman has her ovaries removed and takes tamoxifen for five years, her risk of breast cancer is reduced by almost 90 percent--almost the same as doing prophylactic mastectomy [removing healthy breast(s) to reduce breast-cancer risk]."
* What a family history means If a first-degree relative (a parent or sibling) has suffered from major depression, your risk of becoming depressed is two to three times higher than that of someone without such a history. Research also has found that those with a family history of depression have a greater chance of becoming depressed in the face of stressful events--in other words, it takes less to provoke depression in them than in someone who doesn't have a family history, notes Kenneth Kendler, M.D., a professor of psychiatry and human genetics at Virginia Commonwealth University in Richmond. Also, the severity and/or recurrence of a family member's depression may affect your risk.
* How to beat your odds "Don't feel doomed to depression because you have relatives who are or were depressed," says Lynn Rehm, Ph.D., a professor of psychology at the University of Houston. One of the challenges in considering your risk for any disease that seems to run in your family is to separate how much of the familial connection is due to genetics and how much to the family's environment or circumstances (including health, financial status and other factors). That's why it's important to take care of your mental health by doing the following:
Know the signs of clinical depression. These include sadness, an inability to derive pleasure out of once pleasurable activities, difficulty concentrating, low energy, sleep disturbances or insomnia, appetite problems (or overeating), a drop in self-esteem, a sense of hopelessness or helplessness, and, of course, thoughts of suicide, according to Thomas Joiner, Ph.D., the Bright-Burton Professor of Psychology at Florida State University in Tallahassee. "If you experience any of these symptoms for two weeks running or if you feel lots of them for several days, it would be a good idea to get your self checked," he advises. "The leading treatment is a combination of cognitive [talk] therapy and antidepressants--it gives you the best chance of getting better quickly and of staying better over the long term." (For a referral to a psychologist in your area, call the American Psychological Association Public Education Information Line at 800-964-2000.)
Get a grip on stress. Learn to set limits with people and projects, practice good stress-management skills (such as deep breathing or meditation), or find other ways to ease the pressure. Taking these steps can minimize your susceptibility to depression, Rehm says.
Cultivate supportive social relationships. A recent study at the University of Oregon in Eugene found that depressed women who had insufficient social support--meaning, they didn't have many social relationships or lacked a high-quality support network--were more likely to remain depressed one year after diagnosis than those with larger social networks. "If you have people you can confide in or go to when you're in distress, that's a buffer against depression," explains Rehm.
Cultivate an optimistic mind-set. "Depression is often related to a pest simistic outlook and to feeling hopeless," Rehm notes. If you usually focus on the downside, it may take some effort to turn your outlook around: Start paying attention to negative things you say to yourself and reframe those statements so that they're more positive; also, if you start taking credit for the good things that happen and stop blaming yourself for the bad, you'll begin to change your depressive mind-set, she says.
Eat fish. Not only is the incidence of depression lower in geographic regions where consumption of essential fatty acids is high, but research shows that consuming higher amounts of these fats, especially omega-3s--which are plentiful in salmon, halibut and sardines--may relieve depression and bipolar disorder.
* What a family history means It's especially noteworthy if your mother or sister developed early cardiovascular disease (before the age of 60) or if your father or brother did before age 50, says Richard Stein, M.D., a spokesperson for the American Heart Association and a professor of clinical medicine at Weill Cornell Medical Center in New York City. Premature heart disease (as it's called) almost doubles your risk compared with that of someone without a family history. It's also important to realize that many risk factors for heart disease--including cholesterol abnormalities, high blood pressure and diabetes--can be inherited.
* How to beat your odds "You're not your mother and you're not your father--you have a mix of genes and your own lifestyle, which means you're not necessarily cursed to have their heart problems," Stein says. The key? Avoid whatever unhealthy lifestyle practices they may have followed and improve your own health habits. Here's how:
Don't smoke. "Research suggests that people with a family history of heart disease are more susceptible to the harmful effects of smoking than those without such a history," says genetic counselor Theresa Frezzo. Fortunately, quitting smoking lowers your risk of heart disease fairly quickly: A study at the University of Washington in Seattle found that after three years of being smoke-free, smokers who'd kicked the habit following a heart attack lowered their risk of another heart problem to that of nonsmokers.
Stick with a heart-healthy diet. That means eating lots of fruits, vegetables and whole grains; avoiding saturated fat and trans fatty acids and using mono-or polyunsaturated fats instead; and consuming fatty fish such as albacore tuna, salmon or sardines at least two times a week.
Lose excess weight. Being obese or overweight is associated with abnormal lipids (elevated cholesterol and trigylceride levels, in particular), high blood pressure and an increase in your body's resistance to your own insulin. These conditions all contribute to developing cardiovascular disease. The strain on the heart ultimately will cause it to enlarge, which can lead to congestive heart failure.
Keep other conditions in check. If you have high blood pressure, lipid abnormalities or diabetes, make sure these conditions are well-controlled with lifestyle modifications and/or medication, says JoAnn Manson, M.D., chief of preventive medicine at Harvard's Brigham and Women's Hospital in Boston. And schedule regular screenings to make sure your numbers stay on track.
Talk to your physician about sophisticated screening measures. "If there is early cardiovascular disease in your family, have all your other risk factors measured and discuss your individual risk of heart disease with your doctor," Stein says. "If your risk is moderately elevated, or more, an exercise imaging test would be a good idea." You also may be a candidate for a new blood test that measures C-reactive protein (a marker of inflammation in the blood vessels), as well as blood tests to check homocysteine (an amino acid), Lp(a) (another harmful lipoprotein), or fibrinogen (a coagulation factor)--all emerging as risk factors for heart disease.
RELATED ARTICLE: are you destined to be overweight?
Your risk of becoming obese is two to three times higher than that of someone in the general population if moderate obesity (defined as a BMI from 30-34.9) runs in your family, and five to eight times higher if severe obesity (a BMI of 40 or above) does, according to Claude Bouchard, Ph.D., director of the Human Genomics Laboratory and executive director of the Pennington Biomedical Research Center in Baton Rouge, La. This partly may be because more than 50 genes have been shown thus far to be associated with obesity risk, influencing appetite, metabolism and other weight-related factors.
Just because some family members are overweight or obese, however, doesn't mean you're fated to join them. "Heredity is not destiny when it comes to body weight," says JoAnn Manson, M.D., of Harvard's Brigham and Women's Hospital in Boston. "There is a lifestyle component--obesity is probably one-third genetic and two-thirds environment and lifestyle--so there are ways to beat the odds." But if you've also learned unhealthy eating habits and sedentary ways from your family, you'll need to change your lifestyle. It's as simple as this: Watch your calorie intake and exercise regularly--and you'll greatly reduce your risk for overweight and obesity.
RELATED ARTICLE: exercising your way to risk reduction
It's no secret that exercise provides benefits for health and well-being. Here, three ways that regular workouts can help protect you from hereditary conditions:
Breast cancer Though research has yielded mixed results on the subject, some studies suggest that regular aerobic exercise, especially if it's a lifelong habit, may protect against breast cancer. A study at the University of Calgary and the Alberta Cancer Board in Canada found that postmenopausal women who exercised regularly had a 30 percent reduced risk of breast cancer, and those who had worked out regularly throughout their lives had a 42 percent lower risk.
Depression "If you exercise regularly, you'll be physically healthier and your immune system and your resilience under stress will increase," explains Lynn Rehm, Ph.D., a professor of psychology at the University of Houston. "Exercise [also] enhances your self-esteem and your ability to solve problems." This, in turn, can help you rebound from depression. When researchers at Duke University Medical Center compared the effectiveness of aerobic exercise, antidepressants and a combination of the two among 156 people with major depressive disorder, they found that after four months, people in all three groups experienced significant improvement. After 10 months, however, those who continued working out regularly had significantly lower relapse rates than those just taking antidepressants.
Heart disease Moderate to vigorous exercise--if done most days of the week--also goes a long way toward keeping your heart healthy. A recent study at the Harvard School of Public Health found that even walking regularly--for a total of four or more hours per week--substantially reduced the risk of cardiovascular problems over 14 years among women with diabetes.
Stacey Colino is a freelance writer in Chevy Chase, Md.
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