Ask Us Anything About… Family Health History

Description – The video begins inside a Penn State Milton S. Hershey Medical Center inside the Family and Community Medicine office. Two people are standing next to each other in an office setting. Standing from left to right is Barbara Schindo and Dr. Mack Ruffin.

Barbara Schindo – From Penn State Health and Penn State College of Medicine, this is Ask Us Anything About Family Health History. I’m Barbara Schindo. As researchers are learning that more and more health conditions have genetic links, it’s more important than ever to know your personal and your family health history. Here to talk with us about why this is important and what you need to know is Dr. Mack Ruffin, the Chair of the Department of Family and Community Medicine here at Hershey Medical Center. Thanks for joining us, Dr. Ruffin.

Dr. Mack Ruffin – You’re welcome.

Barbara Schindo – Okay, let’s start with some easy questions. Can you tell us why is it important to know your personal and family health history and what exactly should you know about it?

Dr. Mack Ruffin – So in terms of your family history, it’s really just knowing what health problems your family members had, particularly your parents, your siblings, and your children. We would call them your “first-degree relatives,” and then the second-degree relatives would be your grandparents. And the key part to know is what diseases did they have, when did they get diagnosed with them, and particularly did they die from them early. That’s really important.

Barbara Schindo – Okay. So what types of health conditions are most commonly passed down genetically? You know, things such as heart disease or diabetes. To what extent are diseases like that genetic?

Dr. Mack Ruffin – So they’re both genetic and also what people do. So in particular, hypertension or heart disease, diabetes, if you have a family history where you have a sedentary lifestyle, obesity, and early diabetes comes on, then you both — you’ve got both the environment, what people do, and then probably a genetic component related to that as well.

Barbara Schindo – Okay. What types of — I’m sorry, what about psychiatric issues, such as addiction or depression? Are those typically genetic as well?

Dr. Mack Ruffin – That’s an interesting question. We do think there are genetic components to that, but it’s hard to say, and again, if distress runs in the family over multiple generations, which could include poverty and pain and things where you really don’t have access and you’re really under a lot of stress all the time, that’s probably not so much genetics, but there are clear evidence or some evidence of genetics related to substance issues, like alcohol and opioids, and depression and schizophrenia and lots of other mental health issues. So it’s important to get those. Those are hard to get from your family because often they don’t want to share mental health issues.

Barbara Schindo – Okay, and we’ll talk a little bit more later about how to have that conversation with your family and what you should be asking. So right now you are watching Ask Us Anything About Your Family Health History. We welcome your questions for Dr. Mack Ruffin. You can post your questions in the comment field below this video, whether you’re watching live or on playback, and we’ll get an answer for you. We actually already had a question submitted via Facebook earlier this week by Ann. Ann says that her mother suffered from multiple types of cancer, including pancreatic cancer and cancer of the throat region, so she’s wondering: Is she — should she be concerned about a genetic predisposition for cancer?

Dr. Mack Ruffin – Right. So, Ann, I really — I’m sorry that your mother had to suffer, because those are both two very difficult cancers. First question to ask, these are difficult questions, but does your mother smoke or drink a lot of alcohol, because both of those would increase her risk of having throat cancer and pancreatic cancer. Both of those may have a genetic component to it and both of those together are very unusual. If your mother was still alive, that would be the person to do any type of genetic counseling with because testing the children or siblings really may not reveal what might be the genetic abnormality there.

Barbara Schindo – Okay, thank you. So what are the most common types of conditions that you may need to be screened for if they kind of run in your family?

Dr. Mack Ruffin – So the ones that we know the most about are breast cancer and colorectal cancer and those are the ones that we often really want to know more of the family history, because particularly in colorectal cancer, if you had a family member, so your father died from colon cancer in his 60s, and normally we would — or even in his 50s, normally we would start screening in their 50s, but we might start screening you earlier, and we would really want you to consider getting a colonoscopy versus if you didn’t have that family history, we could offer some other less invasive tests. Breast cancer is another one where if you’ve got multiple family members with breast cancer, we might even consider doing the genetic testing in you versus if you didn’t have that, we wouldn’t do the genetic testing. So the breast cancer and colon cancer are ones, I think, in prenatal or obstetrical care, often the question comes up: Did you have relatives with significant birth anomalies? Did you have problems with people with stillbirths in your family? So then that raises the questions about what we should do differently in your prenatal care. It’s interesting, a lot of times when I ask those questions people look at me like “I don’t know,” or in the cancer, everyone dies from cancer, whereas, cancer is hundreds of different cancers and they all mean something different.

Barbara Schindo – So the key is to know what you need to look out for and get screening as early as possible.

Dr. Mack Ruffin – Right.

Barbara Schindo – Okay. In addition to the health history of your family, you know, if they had cancer, if they had heart disease, if they have high blood pressure, what else is important to know about your relatives? Things like lifestyle?

Dr. Mack Ruffin – Lifestyle is really important, so like with Ann’s case, did her mother smoke, or if you have a family history of a lot of diabetes and you look back and you realize those family members who got diabetes and had lots of complications or even died early from it, so they were sedentary, they also smoked, they were very obese, and if you’re not like that, and we call that the “phenotype” versus the “genotype,” so my father died from lung cancer and was a heavy smoker and didn’t take care of himself and was very overweight, you know, I don’t smoke and I try to take care of myself, so there’s probably not a genetic issue there, so it’s also what did they do that might have placed them at risk for getting that cancer early. If none of that’s there, then there’s more concern that there is a genetic issue going on there.

Barbara Schindo – So even if your family has some of these health issues, it doesn’t always mean that there needs to be medical intervention. It could be lifestyle changes.

Dr. Mack Ruffin – Lifestyle change, and I think people, when they say, “Here are genetics, oh, there’s this genetic risk,” they feel like that that means “I’m predestined to get disease with that genetic,” and there’s very few genes like that. Most of them just increase your risk. It doesn’t mean you’re going to get that disease.

Barbara Schindo – Okay, thank you. So you said it’s important to know your family health history, but how far in the family tree do you need to be concerned with?

Dr. Mack Ruffin – Yeah, people want to — think, well, I don’t know the five or six generations ago, and what we talk about in a pedigree is the first-degree relatives, and if you think about it as a tree and you’re in the middle, it’s the people you can reach out and touch, so your children, your siblings, and then your parents. That’s the ones to really find out about. And then if you want to go to the next level, it’s really your grandparents. Now, your aunts and uncles may be important, but it’s those people. Now, I know a lot of people have — they’re adopted and they don’t know anything about their biological family, so that’s a challenge, or they’re not sure who their biological parents are, and so often I encounter people that when I ask about their father and I probe, I realize, well, that’s who I see as my father, but that’s not my biological father and I don’t know who my biological father is. So, but most people can get some of it, but it’s also how do they ask and when do they ask these questions. It’s too late if your parents and grandparents have already died, but maybe you’ve got some aunts and uncles who can fill in some information for you.

Barbara Schindo – As you said, the easiest way to get this information is to just ask your family, so if you’re going to have that conversation with your parents or your siblings, what is the best way and time to have these conversations?

Dr. Mack Ruffin – Well, you know your family best, so there are some people in your family who just won’t want to talk about this at all, and this time in the year is a great time because Thanksgiving families get together or the end of the year, holidays with Christmas, Hanukah, whatever you celebrate at the end of the year, or even the new year your family will get together. That’s a good time to just bring it up when you’re having those social conversations, and maybe it’s not so much what did grandpa have, what did grandpa die of, is: Tell me more about when grandpa was living. What did he do? What were his hobbies? What did he have that — and keep him from doing those types of things, so you get the story more than just what did he die from and what did he do, and then you might find that there is some concern about asking those questions, or answering, because not many people want to tell you, you had a relative who was an alcoholic or smoked a lot or really didn’t take care of themselves or did other things that might be seen not socially acceptable to want to talk about.

Barbara Schindo – So even though some parts of these conversations may be very difficult, you feel like it’s important for everybody to understand that it’s still very vital.

Dr. Mack Ruffin – It’s very important. I think also if you have a family who’s very focused on their family traditions, the family bible might be a source of information or other family documents that people might have in the household. Even if they’ve gone and done some genealogy, they might find some information and pull in records like obituary reports, or birth records they might report, because a lot of people are really trying to trace their ancestry and they pull in some of those documents and that might reveal some helpful information.

Barbara Schindo – Okay. So it could be as easy as, as you said, pulling out a family bible or an old photo album and saying — just asking a few questions.

Dr. Mack Ruffin – Who is that and how are they related to me, how long did they live, what were they struggling with in their health, you know, what did they die from or when did they die, you know. And the key issues are not so much, oh, they had colon cancer and they died in their 80s. That’s not nearly as important as they had colon cancer and died in their 50s. So it’s what did they die from and particularly if it was early, and “early” is usually before 60. And just, you know, one of the things that’s helpful is: They were healthy and all of a sudden just dropped dead.

Barbara Schindo – That’s something important to pay attention to.

Dr. Mack Ruffin – That’s important to pay attention to because they may have some underlying heart disease that they transmitted to you that’s not the usual type. They might have had some problems with how the heart beats, they might have had some other anomaly that could have been captured or seen, but that sudden death in a healthy person for no explainable reason. Now, died in a car accident, died from gunshot, died from something that we can explain, that’s different, but if healthy — doing all the regular things and just, as we would say, drop dead for no explainable reason, that’s another family health history that’s important to have.

Barbara Schindo – So you had — you kind of touched on this a little bit before about, what about the folks who can’t easily access this information, whether perhaps both your parents have passed away or you don’t know your biological family? Is there a way for those folks to be able to find this information?

Dr. Mack Ruffin – So that gets challenging. If your parents are deceased, if you can get their obituaries or if you can get anything from their doctors or even get something that might have been in their medical record or even health insurance billing where they might have had some billing about what was going on, you could get something. You can try to do other records. If you have no way to get access to your ancestry, there are a lot of online systems, but you need to really check those out because you’re going to spend some money. You’re going to donate your genetics and then they’re going to try to link you to people with similar genetics. There is some validity to that, but that takes time, money, and resources to do that. I think if you know that your family grew up in a specific area, attended a specific church or a synagogue, you might be able to go and get records there. You can get death records, but again, that takes time and insight. You can get marriage records, but it just takes time and often it’s not as accurate as you want. But if you’re really interested and you have the resources and you want to find the time, you can do it and track it down.

Barbara Schindo – Okay. Are there any other tools that you recommend to folks to help them to look at, to help them have these conversations or find this?

Dr. Mack Ruffin – So I think the Surgeon General has a very nice tool about family health history that allows you to collect it and questions to probe on and maybe even put it in a database and print out something you can actually hand-carry or have around and then update it as things change or more information, because what I’ve found is that if patients start talking to different family members, they start to get slightly different answers to the — different stories and maybe you bring those different stories together and try to figure out what did this mean.

Barbara Schindo – Okay. So that link to the Surgeon General’s website that Dr. Ruffin mentioned, we will make sure we put that in the comment field below this video, so if you’re looking for any extra resources or any extra information, you can find that there. So this has been Ask Us Anything About Your Family Health History with Dr. Mack Ruffin, and we welcome you to ask any additional questions in the comment field below, even if you’re watching on playback, and we will get an answer for you. So thanks very much for joining us.