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Pass It On?
With the concept of “pre-existing conditions” making front-page news in the ongoing tug-of-war focused on U.S. health care, it is not surprising that an increasing number of Americans are making more of a concerted effort to track their family health history.
Research reveals that regular check-ups and informative websites barely scratch the surface when it comes to family legacies.
Indeed, just two weeks ago, a new study, published in Nature, revealed breast cancer’s categorization into four major genetic strata that could mean advances in research for cures and for the way the disease is approached.
Doctors and researchers are also learning that not all cancers believed to be hereditary are passed from generation to generation. There is increasing evidence that in some cases, the cancer can be passed through environmental sources, or even exposure to cancer medications among members of the same household.
Indeed, being well-informed about cancer and how it relates specifically to your family and household may be a bigger challenge than previously thought.
According to Dr. Generosa Grana, director of the Cooper University Hospital Cancer Center, in Camden, N.J., people with family histories should dig a lot deeper than their nearest and dearest.
“If you want a thorough family history, you need to go back a few generations, two to three at least,” Grana advises. “In addition to that, you want to get a thorough true sense of what cancers occurred and at what ages, what types of tissues were involved.
“Was your ancestor affected by one cancer or two? What were specific symptoms the relative experienced? You want as much information about the cancer and cancers as possible.”
Though Grana credits the mainstream media for doing a good job in terms of highlighting the importance of family history, Jewish families should take the pursuit seriously, especially as there are many hereditary illnesses in addition to cancer affecting the Jewish community. Grana notes that with so much information now widely available on hereditary illnesses and syndromes, patients and their doctors have taken an equal interest in the context of preventive medicine.
“We’re just in our infancy in terms of learning about the true impact of genetics, ” she continues. “Breast and ovarian cancer and their hereditary issues have gotten the most media attention, and for the Jewish community they are the most common.
“In the Jewish community you are also concerned about other conditions, such as Tay Sachs, that involve children, so this also makes inquiry into hereditary illnesses in addition to cancer important.”
Grana explains that one major problem in tracking syndromes is that they are more complex phenomena that extend to several organs. It takes more aggressive research for families to evaluate their predisposition, she says.
“Based on what you know about cancer and your family history, you may be able to change lifestyle” and nutritional approaches, as well as exercise and other lifestyle decisions, such as when you decide to have children. “If you come from a family with high coronary disease risk, that is a family where nutrition and exercise plays a role.
“One important caveat to note is that cancers in families are occurring at younger ages. Our reproductive lives have changed; having children later in life and children hitting puberty earlier” — all such things could be “having an impact.”
Dr. Kristin Brill, head of the Janet Knowles Breast Cancer Center at Cooper University Hospital, is a cancer surgeon. She points out that genetic research has had a profound impact on how she can advise patients on a variety of issues, from what kind of surgery to have if diagnosed to different means of preventing the onset of illness. She also urges patients to be aware of the presence of abnormal BRCA1 and BRCA2 genes (linked with breast cancer) in their family histories. If they are prevalent on both sides, dig a little deeper, she cautions because “it is not uncommon for some patients to think paternal histories have no bearing,” and cancer risk “is only passed through the mother’s side,” says Brill.
“From my perspective, the idea that there is more focus and accuracy in genetics is very exciting because it advances what we can do for patients.”
She adds that “we can now go from an attempt at early diagnosis to specific preventative measures tailored for that patient, based on a family history. We can counsel young patients early on and offer them risk reduction courses of action, such as medication, surgery or even close surveillance, to potentially prevent the cancer from happening.”
While different cancers running in families should prompt its members to never take anything in a family history for granted, there are other medical issues affecting families affected by cancer. Theresa O’Keefe, chief scientific officer at the Pharma-Cycle (www.pharma-cycle.org), stresses 24 of the most common drugs used in cancer treatments can cause cancer in other family members if proper precautions are not taken.
“Though many of the drugs kill cancers by killing cancer cells, they can also cause cancers when other people in a patient’s household are exposed to them in smaller doses somewhere else,” O’Keefe explains.
“Eighty-five percent of patients are sent home after they receive infusions, and two to five days after treatment, all [family] members are potentially in danger from the effects of these drugs. Once exposed, drugs can absorb into the skin, pass through the body and cause cancer in other members in about 10 years.”
To help stave off the potentially deadly residual effects of post-chemotherapy drug exposure, Pharma-Cycle has created a kit for cancer patients, which O’Keefe describes as “tools to create a cocoon around themselves to protect their home and family members” from exposure to harmful chemicals.
She also advises families to visit the treatment and side-effects section of the American Cancer Society’s website (www.cancer.org/Treatment/TreatmentsandSideEffects), and take common-sense precautions — avoiding close contact with the patient in treatment;, flushing the toilet twice; using disinfectant wipes on surfaces; and having no intimacy during treatment.
“When huge quantities of these drugs are circulated, they are incredibly dangerous,” O’Keefe cautions. “Oncology nurses and pharmacists who work with chemo-drugs will often die of cancer by working with patients.
“While it is not a true heredity-caused cancer, what makes it a family matter is the potential for patients to pass the chemicals on to their family members through exposure. One thing that is reassuring, however, is that exposure is preventable; people can make sure they avoid surfaces in their home or their affected family member until a certain amount of time passes after the patient is treated.”
O’Keefe also adds that based on her 25 years of experience and research, she and her colleagues have discovered that there is a good chance that a lot of the cancers that appear to be hereditary may in fact be environmental.
“For many years working in research to understand cancer, it used to be cancer happened once in a while within a family,” she adds. “Later, we started seeing families where one member would develop cancer at 50, and in the next generation another family member would get it at age 20.
“It seemed heredity, but in the wake of our research, we now have to question if the cancer is hereditary or if it happened because of exposure to the family member being treated with certain medicines or other things, like smoking or excess sun exposure.”
Elyse Glickman is a writer with an expertise in travel and health issues.
This article originally appeared in a special "Fighting Cancer" section of the Exponent.