Why Knowing Your Family Health History Matters

Knowing your family health history can be as crucial to your health as knowing your health numbers. After all, the Human Genome Project estimates we have between 20,000 to 25,000 genes in our bodies — and they're a roadmap for our overall function and health.

Given that many conditions have such genetic links, the more we know about our family's health, the better snapshot we have of our health.

We spoke with Dr. Nikhila Reddy, a primary care doctor at Houston Methodist, about the importance of a family health history, how to create one and what should be included.

What is a family health history, and why is it important?

A family health history is simply a history or record of the diseases and conditions that family members have experienced.

Being familiar with our family members' health can help us (and our doctors) stay on top of our mental and physical health. Conditions such as heart disease, stroke, diabetes and certain types of cancer have a genetic link and can run in families. In some instances, a well-researched family health history can help doctors identify gene disorders or chromosome abnormalities that can lead to conditions such as breast cancer, colon cancer or even cystic fibrosis.

And while genes don't necessarily determine whether we'll get a disease — if many of our family members have experienced the same condition, it can be a health risk factor to consider.

We can aim to control other health risk factors, such as our diets, whether we drink or use tobacco, and get enough physical activity and sleep.

Some of these habits and behaviors can run in our families, too. For example, second-hand smoke exposure from, say, both of your parents smoking a pack a day, plus your own smoking for a number of years in your youth, may have an effect on your "pack years" and need for lung cancer screening down the line. Pack years is an estimate of a person's cigarette smoking — and exposure to cigarette smoke — over time.

"The reason we ask about family history is because we're trying to find out what medical conditions a patient might be at high risk of developing in the future," Dr. Reddy says. "It gives us an idea if we should start screening for certain medical conditions sooner rather than later.

"There are recommended age intervals for preventive lab tests and cancer screenings — but we can always start earlier if that's indicated for the patient. Our goal as primary care physicians is to anticipate the needs of our patients so that they can remain healthy for as long as possible."

What needs to be in a family health history?

Building a family health history might feel like you're going down a health ancestry rabbit hole. That's because it's recommended to know the health history of our first-, second- and third-degree relatives. That means parents, siblings, half-siblings, children, grandparents, aunts, uncles, cousins and any nieces or nephews. Both the maternal and paternal sides of your family should be considered and included, even if you share more resemblance with one side over another.

"I recommend asking siblings, parents, your parents' siblings, and grandparents," Dr. Reddy says. "I suggest asking about common health conditions first, since most people remember the names of these medical conditions or at least the nonmedical term for them. Do they have high blood pressure, diabetes, high cholesterol, or any heart-related conditions?

"It can also be helpful to ask about any behavioral health/mental health conditions, along with autoimmune and rheumatological conditions. It's important to ask about any types of cancer in the family and at what age they were diagnosed. As a family medicine physician, these are the types of conditions I tend to see more often and knowing this information in advance helps us determine the future care of a patient."

How to create a family health history

If you're reading this thinking, "This sounds like a lot of work," yes, there is an amount of effort you'll need to make to capture this information. However, it's better to have this info readily available than struggling to fill out a questionnaire when you're already in a doctor's office drawing a complete blank. The U.S. Surgeon General offers a web-based My Family Health Portrait tool that allows you to create, edit and share your family health history.

So how do you collect this information? Have conversations with family members! You could potentially start with your parents to get an understanding of their health, their parents' health (especially if they passed away before your birth) and that of their siblings. You could also go to any second- or third-degree relatives directly.

No matter who you go to, Dr. Reddy suggests approaching the ask by providing context to the conversation.

"For example, you can approach it by saying, 'I'm going to see my doctor soon for a physical. I'm trying to find out if there are any health conditions in my family so that my doctor can be informed and manage my healthcare accordingly. Can you help?'" Dr. Reddy says. "Some people consider their health history to be private information, so if you ask them all of a sudden without an explanation, they may not be as inclined to let you know or will deny having any diagnosed health conditions."

Questions to ask to build a family health history

• Has anyone in our family had cancer? What type of cancer? Have multiple people had the same type? How old were you/they when diagnosed? Did anyone have more than one type of cancer? Did they have any risk factors for the cancer? (Smoking, drinking, being overweight?) Do you know if any of our family members have had genetic testing completed related to cancer?
• Do you have any chronic conditions? Do you know of anyone in our family having chronic conditions, such as high blood pressure, diabetes, heart disease or asthma? Do any autoimmune conditions run in our family, such as rheumatoid arthritis, multiple sclerosis or lupus?
• Do you know of any family members who have experienced any mental health concerns such as substance use disorder, depression, schizophrenia, obsessive-compulsive disorder, anxiety or attention deficit hyperactivity disorder (ADHD)? Do you know how old they were/you were when diagnosed? Has anyone in the family ever died by suicide? How old were they when they passed away?

Dr. Reddy also suggests additional questions for your parents.

"For female patients or patients who have a uterus and ovaries, it can be helpful to ask their mother or parent around what age they started menstruating and the age they reached menopause," Dr. Reddy says. "Sometimes patients who are in their early 40s come in concerned about menopause symptoms, such as hot flashes, but they're still getting their menstrual cycle, which can be confusing.

"Patients in this scenario are likely premenopausal, indicating that they may reach menopause in the near future, and will eventually stop menstruating. If their mother or parent reached menopause in their 40s, then the patient might experience menopause around the same age, instead of reaching menopause around the average age of 50. It provides a clue as to what's going on and helps reassure the patient that this is a normal physiologic process."

Related: Do Gynecologic Conditions Run in the Family?

Men may want to ask their fathers specifically about prostate cancer.

"If there are paternal family members who were diagnosed with prostate cancer at a younger age, around age 50 or less, we may consider checking the prostate-specific antigen (PSA) screening lab test when the patient is around the same age," Dr. Reddy says. "Generally, we don't check a PSA as part of the routine labs for an annual physical. This is because the PSA is not a very accurate test to help diagnosis prostate cancer.

"It can also be elevated due to non-cancer-related prostate conditions like prostatitis (temporary inflammation of the prostate due to an infection) or benign prostate hypertrophy (enlargement of the prostate that naturally occurs with aging). Some older patients may still request a PSA, and we'll consider adding this to their routine labs to help reassure the patient."

I'm adopted or estranged from my family. What should I do?

For those whose family ties are strained for whatever reason, you can try to be creative and talk with any relations with whom you're in contact or have somewhat friendly relationships to see if they can help track down information for you.

"These conversations can be difficult, especially if you don't know the person very well or if you don't have a reliable way to contact them," Dr. Reddy says. "If you know a family member or friend who might get along with them, you can reach out to them instead to see if they can find out for you."

Dr. Reddy acknowledges that individuals who were adopted face unique challenges with this topic.

"I've found that oftentimes we don't succeed in finding their family history," Dr. Reddy says. "They can try asking their adoptive parents, as they might know a little bit of their family health history. They can also try contacting the adoption agency, but sometimes biological parents prefer to keep their information private or prefer not to be contacted. If we don't know a patient's family history, we follow the recommended guidelines for age-appropriate screenings like we would with any other patient."

How to use your family health history

After you have built the history, you'll just need to update it routinely as anything changes with a family member's health. You can share it with any siblings or children who may also benefit from your work. But, ultimately, the person you'll want to share this with is your primary care doctor at your next appointment. However, if you noticed that many family members have had the same condition, Dr. Reddy says you may want to move up your appointment date to discuss it with your doctor.

"Cancer tends to be the major red flag, especially for certain cancers like breast cancer and colorectal cancer," Dr. Reddy says. "If you have a first-degree relative or multiple second-degree relatives who were diagnosed with these cancers around the age of 40 or less, I recommend letting your PCP know sooner rather than waiting until your next annual physical.

"In these situations, we can start screening mammograms in your 20s or 30s, and we can do genetic testing for breast cancer. For colorectal cancer, we may start screening colonoscopies 10 years prior to the age your family member was diagnosed. By taking these interventions, we can catch the cancer earlier and provide a better life outcome for the patient."

Dr. Reddy emphasizes that learning about our family's health history can both motivate us to make healthy changes to our lifestyle and be demoralizing if, after all these changes, we still fall prey to a condition that runs in our family.

"Sometimes we try to do all the right things — eat healthy, exercise, and make sure we're taking care of ourselves — but our family history may counteract that," Dr. Reddy says. "This can be disheartening for some patients, especially if they don't see improvement with their labs or if they end up getting the same medical condition despite their efforts.

"From a cardiovascular standpoint, they're still benefiting from their healthy lifestyle, and I highly encourage them to continue instead of quitting. They may only develop a milder version of the same health condition and are able to avoid the health complications their family member experienced, subsequently living longer and having a better quality of life."