Some of the most common cancers like breast, prostate, colon and melanoma, have hereditary components, meaning they can be passed through a person's genes, yet many families don't make an effort to track the history of cancer in their relatives.
This information is crucial when assessing one's own cancer risk, especially now that genetic testing has become much more accessible. Sharing with your health care provider who in your family has had cancer and what type can not only help them determine whether genetic testing is right for you — but it can also inform the lifestyle changes you might want to make to reduce your risk of the cancers in your family.
For some people, that could mean using sun block every day while others might need to be screened for a type of cancer more frequently and starting at a younger age. The Centers for Disease Control and Prevention also offers advice for how to act on your family health history.
But familial cancer risk isn't just about genes, Laura Koehly, a senior investigator at the National Human Genome Research Institute within the National Institutes of Health, told TODAY.
"It's shared biology. It's also shared environments, and those shared environments might reflect behaviors," she explained. "We learn from our parents and our siblings, and then we transfer that sometimes to our children. Understanding all of these different components that make up family health history as a risk evaluation tool can give us insights into the things that we have control over and the things that we don't."
Gathering your family's history of cancer, she said, is an "important first step."
What information should you seek out when asking about your family's history of cancer?
Rachel Pearlman, a licensed genetic counselor in the clinical cancer genetics program at The Ohio State University College of Medicine, stressed the importance of finding out:
- The type of cancer a family member was diagnosed with.
- The age of diagnosis of the family member.
- Whether family members had more than one type of cancer, and making note of the above information even if it wasn't fatal.
She also emphasized that you should ask these questions of both sides of the family.
"A lot of people will have the assumption particularly for your breast cancer risk that ... my dad's side of the family wouldn't impact me, but it's really important to make sure that we're assessing both sides," she told TODAY.
Learning whether the cancer spread to other parts of the body can also be helpful, and it's also important to get specific about type. For example, some families might prefer to say grandma had "a female cancer," but that includes both cervical and ovarian, and "one has hereditary risk, and one typically does not," Pearlman said.
The biggest "red flags" in family cancer history, as she called them, are diagnoses of the following cancers, especially under 50 years old:
- Advanced prostate cancer.
Amanda Ganzak, lead genetic counselor for the Smilow Cancer Genetics and Prevention Program at Yale Cancer Center, said that the signs of increased cancer risk she also looks for are:
- The same cancer in multiple relatives on the same side of the family.
- Rare cancers, like men with breast cancer.
- Certain ancestral backgrounds, like Ashkenazi Jewish.
It's a lot of information to gather, so Koehly recommended starting with first- and second-degree relatives. That means:
- Siblings and half-siblings.
- Aunts and uncles.
- Nieces and nephews.
"Just one first-degree relative with a diagnosis of cancer increases your risk for cancer and would put you in a group where you would be screening at an earlier age and more frequently," Koehly said. "If you have more than one first-degree relative, then that might be sufficient to move you along for a genetic service."
Two second-degree relatives on the same side of your family also indicates increased risk, she added.
What's more, Koehly said the overall map of cancer diagnoses on one side of the family can indicate whether a hereditary syndrome that increases risk for multiple types of cancers, such as Lynch syndrome, exists in the family.
What's the best way to start the conversation with your family?
Some families may be easier to talk to and have more information more easily accessible than others. Here are some tips to navigate a range of family dynamics.
Find your "family historian." Research shows many families have one or two people who organize information about family health on behalf of the whole family, said Dr. Michael Hall, chair of the department of clinical genetics at Fox Chase Cancer Center at Temple Health. He recommended starting with this person.
Ask beyond your immediate family. The more people you talk to in your family, the more likely it is you'll be able to create an accurate picture of who was diagnosed when, Hall said. While it's natural to assume the information a parent gives you about extended family is accurate, actually speaking to those members could uncover even more helpful info. He added that research shows women tend to be more up to date on family health information than men.
Explain why you want the information. Family members hesitant to talk about cancer might be more willing to open up if you explain you want the information to take it to your doctor and it would benefit the family as a whole, Ganzak said. Let them know "I'm not just asking to be nosy," she added. "I'm asking because it impacts the health decisions that me and my providers are going to make and allows us to plan appropriately."
Approach people in a comfortable environment. If you want to reach out to a specific person who's uncomfortable with the subject matter, Pearlman advised thinking about whether they'd be more comfortable talking one on one or in a group setting. In her experience, family reunions and holidays can be a great time to get the conversation started, but for some people, it might be overwhelming and a phone call would be better.
Try framing the conversation around family memories. In some cases, people might not remember when someone was diagnosed with cancer, but they might remember when they did something for a sick relative, Koehly said, adding that asking about when something happened more generally can help jog memories.
If all else fails, look for death records and obituaries. Death records will have a cause of death on them, as will some obituaries, so Pearlman recommended searching there if you're struggling to find info about specific family members. The CDC has a guide for obtaining death and other vital records.
Once you've gathered this information, the next step is to take it to your primary care provider, Koehly said. Your PCP can then assess what next steps are appropriate, from genetic testing and counseling to early and more frequent cancer screenings or lifestyle changes.