Family Health History and Colorectal Cancer

Family hike

Utah is known for many things including beautiful national parks, award winning Shakespeare, fry sauce (“yes!”), and a long standing tradition of family history research. Many Utahns are passionate about gathering information about their ancestors. Thanks to a particular great aunt, I count myself fortunate to have family history records extending back to the 1500s. Whether we are descended from a princess, a pirate, or like many Utahns, a pioneer, family history helps define who we are. Stories of our ancestors make us laugh, cry, beam with pride, and sometimes blush with embarrassment.

Sadly, despite the extensive research of my great aunt, I know relatively little about my family HEALTH history. Like most people, I’m aware of certain health problems in close family members, but have not taken the time to gather health information on more distant relatives. As a Genetic Counselor (a health professional who specializes in analyzing family histories for the presence of hereditary disease), I’m somewhat embarrassed to admit this fact. But, like everyone else, I’m busy with work, home, kids, etc. There just never seems to be enough time or motivation. Fortunately, March is colorectal cancer awareness month. It is a great time to learn about the risks for colorectal cancer and what can be done to prevent it.

So, what does family history have to do with colon cancer anyway?

Approximately 1 out of every 25 men and women will be diagnosed with colorectal cancer during their lifetime. Although colorectal cancer is still the second leading cause of cancer related death nationwide, fewer people die from colorectal cancer today than have died in previous years. This is due to improved colon cancer screening and treatment. Colonoscopy screenings save lives by finding and removing precancerous colon polyps before they develop into cancer. Since most people with colorectal cancer are diagnosed over the age of 50 and do NOT have a family history of colorectal cancer, routine colonoscopy screening beginning at age 50 is sufficient for most men and women.

Approximately 1 out of every 5 people diagnosed with colon cancer has a family member with colon cancer. In many families, this is the result of relatives sharing a common lifestyle or other environmental factors. Recognizing these factors allows family members to reduce the risk for colon cancer by making positive lifestyle choices. Increasing physical activity and eating more fruits/vegetables and whole grains while giving up smoking, limiting alcohol use, and eating less red meat will lower the average person’s risk for colorectal cancer.

Approximately 5-10% of families that have multiple relatives with colon cancer actually have a hereditary cancer gene running in the family. Over the years, we have learned about several genes that cause hereditary colon cancer conditions. Two of these conditions are Lynch syndrome and Familial Adenomatous Polyposis (FAP). In these families, relatives have a significantly increased risk (50% to nearly 100%) of being diagnosed with colorectal cancer. Lynch syndrome and FAP are also associated with cancer diagnosis at younger ages. Relatives of people with these diagnosis have been diagnosed with cancer as young as age 20.  Because of these significantly increased risks, it is very important for individuals with a hereditary cancer gene to begin screening colonoscopies in their 20s-30s (in some cases, even younger) and to have more frequent colonoscopies.

What should I look for in my family history?

Family histories do not always reveal the risk for hereditary colon cancer genes. However, there are some tell-tale signs including:

  • Multiple affected family members in several generations of the family (siblings with cancer; grandparent, parent and children with cancer, etc)
  • Family members who were diagnosed with colorectal cancer before the age of 50
  • Multiple types of cancer in the family. In addition to colorectal cancer, Lynch syndrome is associated with uterine and ovarian cancers.
  • Family members with many colon polyps. FAP is associated with 10 colon polyps up to hundreds of colon polyps.

I’ve collected my family HEALTH history information. Now what?

Once you have collected information on your family members, take time to make an appointment with your doctor or a Genetic Counselor to review the information, discuss your personal risk for colorectal cancer, and, if needed, schedule appropriate screening tests.

What is Genetic Counselor?

Genetic counselors are health professionals specifically trained in analyzing family histories and the role genes play in health and disease. Genetic Counselors can identify potential hereditary diseases in a family and help individual family members understand their risk of being affected, options for genetic testing (including benefits and limitations), health management, disease prevention, and where to locate additional information such as community support resources.

Intermountain Healthcare offers cancer related genetic counseling services at Intermountain Medical Center, Utah Valley Regional Medical Center, American Fork Hospital, McKay-Dee Hospital, and Logan Regional Hospital. Genetic Counseling services will soon be available at Dixie Regional Medical Center as well.

Along with enjoying the many wonderful things Utah has to offer this March, I hope you will join me in gathering your own family HEALTH history information, understanding your risk for colorectal cancer and taking steps to prevent it.