Heirlooms, Hope Chests,and Genes…What did you inherit?Kristen Rasmussen, MS CGC
Your family history The cheapest genetic test that exists
What to ask about your familyhistory? How old now or when died? What diagnosis (this can be tricky!) What age when diagnosed? With cancer – where did the cancer START? Did they get cancer more than once?
What might you find? Cancer Heart disease Diabetes Alzheimer’s disease Lung disease (COPD, emphysema)
What can you do about it? Knowing your family history can help you know what you might be at risk for! Help guide screening Help instigate change Ultimate goal to prevent history “repeating itself”!
1st 2nd 3rd degree degree degree relatives relatives relatives Great Grandparents Grandparents Great Aunts and Uncles Parents Aunts 1st cousins UnclesYou Nieces Great Nieces Siblings Nephews and Nephews Great Children Grandchildren Grandchildren
What if your family historyreveals Cancer? 1 in 3 people get cancer in their lifetime Most cancer is not strictly inherited 2nd leading cause of death in the US 1 in 4 deaths
Breast cancer RiskAverage woman 1 in 12First degree relative 1 in 8diagnosed >55First degree relative 1 in 6diagnosed <55First degree relative 1 in 3diagnosed <45First degree relative with 1 in 2bilateral breast cancerHarper, Peter S. Practical Genetic Counselling, Fifth Edition. Reededucational and professional publishing 1998.
Hereditary Breast and OvarianCancer Approximately 5% of all breast cancers Up to 87% risk of breast cancer by age 70 44% risk of ovarian cancer by age 70 Red flags Young age of diagnosis (under age 50) Bilateral breast cancer Breast and Ovarian in a single individual Male breast cancer
What can I do differently? Be diligent about screening Talk to your doctor about options GAIL model Uses personal history, family history to calculate risk for breast cancer If risk is high enough, can help to determine MRI, preventative medication eligability Change risk factors that can be changed Reduce alcohol consumption Avoid hormone replacement therapy Maintain healthy body weight Exercise regularly
Colon cancer RiskAverage individual 1 in 50One first degree relative 1 in 17One first degree and one 1 in 12second degree relativeOne first degree relative <45 1 in 10Two first degree relatives 1 in 6Houlston R.S. et al. (1990) Screening and genetic counselling forrelatives of patients with colorectal cancer in a family cancer clinic.Br.Med. J. 301. 366-368.
Lynch syndrome Approximately 5% of all colon cancer diagnoses Up to: 82% risk for colon cancer 71% risk for endometrial cancer 12% risk for ovarian cancer 13% risk for stomach cancer Red flags Young age of diagnoses (under age 50) More than one individual with Lynch-related cancer Two Lynch related cancers in same individual
What can I do differently? Increase screening! Colon cancer is one of the few cancers that can be PREVENTED by screening Those with a first degree relative should be getting colonoscopies at least every 5 years (annually for those with Lynch syndrome) May need to start screening younger Again, change risk factors that can be changed Quit smoking Reduce alcohol consumption Lose weight Get active!
What if your family historyreveals Heart disease? 1 in every 4 deaths in the US is due to heart disease* High blood pressure, high LDL cholesterol, and smoking are the three biggest risk factors for heart disease* ½ of Americans have at least one of the above risk factors** CDC website http://www.cdc.gov/heartdisease/facts.htm
Death due to Woman age 35- Man age 35-55Heart attack 55No close family 1 in 90 1 in 60memberMale 1st degree 1 in 36 1 in 12relativeFemale 1st degree 1 in 12 1 in 10relativeHarper, Peter S. Practical Genetic Counselling, Fifth Edition. Reed educationaland professional publishing 1998.
Cardiomyopathies Usually genetic; 55-70% have 20-50% genetic; genetic identifiable mutations testing not as good Dilated Hypertrophic
Familial Thoracic Aortic AneurysmDissections (TAAD) Widening of the blood vessel leading away from the heart (the aorta) If ruptures, can cause sudden death Associated with some genetic syndromes such as Marfan syndrome Can also be isolated though Genetic testing available, but many families have an undetectable mutation
Familial Hypercholesterolemia Very high LDL (bad) cholesterol levels, from birth 1 in 500 people have it 1 in 1,000,000 have a severe form (double dose, inherited from both parents)* Figure from “Familial Hypercholesterolemia, An educational booklet for patientswith familial hypercholesterolemia” by Dr Leiv Ose
Heart history red flags Sudden cardiac death, unexplained death at a young age, or death by an unexplained accident or drowning. Heart attack prior to age 50. Heart failure at a young age (under 50). Signs of heart failure include shortness of breath, fatigue, weakness, difficulty with exercise and "asthma" that doesnt improve with an inhaler. Palpitations or an abnormal heart rhythm at a young age. Fainting, black-outs, or seizures that couldnt be treated with typical seizure medications. More than one relative with the same type of heart disease.
What can I do differently? Talk with your doctor about screening and preventative options (differs depending upon the form of heart disease in your family) Periodic echocardiograms for those with a family history of cardiomyopathy or Familial Thoracic Aortic Aneurysm Dissections (TAAD) Medications/implantable devices for those found to have early stages of cardiomyopathy/TAAD Early cholesterol screening (in early childhood) for families with familial hypercholesterolemia. Medications for those with elevated cholesterol levels Change environmental factors that can be changed (again, differs depending upon form of heart disease) Manage cholesterol, blood pressure, diet, exercise
What if your family historyreveals Diabetes? 1 in 12 Americans have diabetes* 1 in 4 over the age of 65* If current trends continue, 1 in 3 by 2050* Vast majority (95%) are type II diabetes Age, obesity, family history, a history of gestational diabetes, inactivity, and race/ethnicity are major risk factors*CDC website http://www.cdc.gov/features/diabetesfactsheet/
Diabetes Type I Type IIGeneral Population 1 in 300 1 in 100 to 1 in 12With affected 1 in 14 1 in 10silbingWith affected 1 in 25 1 in 10parentWith two affected 1 in 2parents
MODY (Maturity Onset Diabetesof the Young) 1-5% of the cases of diabetes in the US Caused by a single gene alteration in a gene that affects the pancreas’ ability to produce insulin Affected individuals often thin, with no risk factors for diabetes Can present in childhood, but may remain undetected until adulthood Often can be managed with medications, rather than insulin If untreated, can cause damage to eyes, kidneys, nerves, blood vessels
What can I do differently? Talk to your doctor More frequent/earlier screening Change risk factors that can be changed Exercise /diet Get blood pressure/cholesterol under control Weight loss Losing 5-7% of body weight and getting 150 minutes of moderate exercise/week can reduce risk of diabetes by 60% in high risk individuals* * CDC website http://www.cdc.gov/features/diabetesfactsheet/
What if your family historyreveals Alzheimer’s disease?Alzheimer’s disease Lifetime riskGeneral population 10.5%Affected first degree relative 20-25% Additional affected relatives probably increases this risk One study showed that for people with an affected parent and sibling (prior to age 70), the risk to develop AD was 35- 45% If both parents affected, also likely increased risk
ApoE and the link to Alzheimer’sdisease Apolipoprotein E is a protein that is important in carrying cholesterol and fat in the bloodstream Several varieties of this gene. ApoE2 ApoE3 (most common) ApoE4 The ApoE4 version of the gene has been linked to an increased risk of Alzheimer’s disease Women with e4/e4 genotype have a 45% risk of developing AD by the age of 73 Men with e4/e4 have a 25% risk ApoE2 may have a protective effect
Individuals with AD and Normal All Individuals PositiveAPOE Controls with AD FamilyGenotype (n=304) (n=233) History of Dementia 1 (n=85)e2/e2 1.3% 0% 0%e2/e3 12.5% 3.4% 3.5%e2/e4 4.9% 4.3% 8.2%e3/e3 59.9% 38.2% 23.5%e3/e4 20.7% 41.2% 45.9%e4/e4 0.7% 12.9% 18.8% Modified from Jarvik et al 
What can you do differently? ApoE is NOT typically recommended as a predictive test Even those with e4/e4 have a greater chance of NOT developing Alzheimer disease No effective prevention If concerned about risk, could consider a baseline neuropsych evaluation Provides a baseline study to compare to in the future, should concerns arise No preventative medications, but medications approved to treat early stages of AD Clinical trials (www.clinicaltrials.gov)
Early onset Alzheimer’s disease Under age 60 (though not a strict cut off) Accounts for less than 5% of people with Alzheimer’s disease Strongly genetic PSEN1 (30-70%) PSEN2 (less than 5%) APP (10-15%) Other genes, currently unknown
What if your family historyreveals Lung disease Rates in women have increased over the past 20 years Smoking increases risk of Chronic Obstructive Pulmonary Disease (COPD) by 12-13 times 75% of COPD attributed to smoking
Alpha 1 antitrypsin deficiency 1 in 5000 individuals Lung disease after age 20 Smoking significantly increases the risk for lung disease and the age of onset Liver disease from infancy to over age 50 Extremely common to be a carrier (1 in 15 – 1 in 20) Very common among Scandinavians Carriers have a slight increase in risk for lung/liver disease
Alpha-1-antitrypsin Red flags Early onset of emphysema (age 45 years or less) COPD – emphysema or chronic bronchitis Family history of emphysema/COPD, liver disease Asthma with minimal response to medication, inhalers Liver disease with unknown cause http://www.alpha1health.com/patients-and- families/testing-for-alpha-1/alphatest-kit.html
What can you do differently? Avoid environmental exposures! Smoking / 2nd hand smoke Dust/fumes/occupational exposures (wear a mask) Avoid other risk factors for liver disease for those with Alpha-1-antitrypsin deficiency Talk with your doctor Screening available, recommended for those who smoke
How to record your own familyhistory Ask questions! Ask not just “who”, but also how old? Ask about illnesses, and what age they were when diagnosed For cancers, ask where did the cancer START? Write down the answers Update regularly Share your project with your family – they will be more likely to help and become interested! https://familyhistory.hhs.gov/fhh- web/home.action
How can I get records on adeceased family member? Find out where they were seen for their care Next of Kin has right to sign for medical records to be released. Spouse Children / Parents Siblings / Grandchildren Uncles, Aunts / Neices, Nephews / Great Grandchildren Sign a release of Information form Free if records released to a medical provider Can be cost if released directly to you
DNA banking A way to save blood/DNA for the future Costs around $100 (not covered by insurance) Available at a number of private laboratories