Talking turkey about your family history

Lindsay Metcalf, MS, CGC

Prisma Health Cancer Genetics Program

It’s Thanksgiving. Food is on the table, football is on the television and multiple conversations occur simultaneously: Who is working where now? Why IS cousin Jessica marrying that guy?

Then, the inevitable lull in the conversation hits. “So, exactly what was it that grandma had, uterine or cervical cancer?” someone pipes up. Everyone else stops mid-chew, eyes avert and silence ensues until Uncle Bill loudly says, “How ‘bout those Tigers?” Grandma’s uterus ranks right up there with politics and religion as a topic of conversation not suitable for polite company. But genetic counselor Lindsay Metcalf said it’s something that should be discussed.

Why is it important to know your family history?

According to the U.S. Department of Health and Human Services, 96% of Americans believe that knowing their family history is important. Yet the same survey found that only one-third of Americans have ever tried to gather and write down their family’s health history.

“I have worked with thousands of families assessing their family histories, discussing risk factors for specific inherited conditions, facilitating decision-making about genetic testing, and interpreting results in the context of each individual’s situation on a level that they can understand and act upon if necessary,” Metcalf said. “Lack of accurate knowledge about family medical history is a major obstacle to accurate genetic counseling. While some circumstances that lead to this lack of information are insurmountable (adoption, death of a relative at a young age, estrangement), many times the obstacle is that no one asked.”

Are at-home genetic tests useful?

Recently, many have turned to at-home genetic tests to try and gain some understanding of what their DNA can predict about their future health. However, Metcalf said it is important to understand these limitations of at-home medical genetic tests:

• The presence of a genetic change in many cases does not indicate a 100% chance of developing a condition.
• Results from at-home testing must be validated by a clinical genetics laboratory before being considered actionable, as many cases of misinterpreted results exist.
• Negative results do not mean that the chance of having a particular condition is eliminated.

She said the best place to start unraveling what your DNA can tell you is with a consultation with a genetic counselor.

“If there is an indication for testing, we are trained to select the most appropriate test for each family. We understand that deciding about genetic testing and adjusting to the results requires a human touch, and we are equipped with skills to walk you through those processes. Often people feel empowered by genetic testing results and make changes that quite possibly can alter their family tree. But not everyone wants genetic testing, and we respect that everyone can make their own decisions. It’s also important to remember that no family has perfect genes – we all have mutations.”

Several online tools are available to help you get started, such as the Centers for Disease Control and Prevention’s My Family Health Portrait. The cost of genetic testing has dropped dramatically, and many insurance providers cover these costs.

When you are with your family this holiday season, take the first step of simply asking. Remove the awkwardness of asking health questions and sharing information. The information you learn may have a huge impact on the health of your family for generations to come.