Like Mother, Like Daughter?

Just because your family health tree is ripe with lots of scary diseases doesn’t mean your future will be filled with doctor’s appointments. Here’s how to take control of your medical destiny.

Like Mother, Like Daughter?
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You might be surprised to learn that having a mother with breast cancer doesn’t significantly increase your risk in and of itself. What matters more is her age at diagnosis: A mom diagnosed in her 60s would elevate your lifetime risk about 1 percent above the general population’s of 12.5 percent, explains Sherry Boyar, M.S., C.G.C., a genetic counselor at Memorial Sloan- Kettering Cancer Center in New York. But if mom got her news at age 45 and grandma at 60, your risk doubles to 25 percent. Have more than one first-degree relative (parent, sibling or child) with breast cancer at 45? Your risk triples. As for ovarian cancer, a maternal diagnosis boosts your risk from 1.5 percent to between 4 percent and 7.5 percent. You may want to consider meeting with a genetic counselor to discuss testing for BRCA gene mutations if you have any of these risk factors: Your mother or sister was diagnosed with breast cancer before age 45; you have multiple family members with breast cancer; or you have a family history of ovarian cancer or male breast cancer. BRCA mutations are linked to a lifetime breast cancer risk of up to 85 percent (15 percent to 60 percent for ovarian cancer). Women of Ashkenazi Jewish ancestry are 10 times more likely to have a BRCA gene mutation than the general population and should seek genetic counseling for any history of breast or ovarian cancer, regardless of age. The numbers are not so clear for hereditary lung cancer. But Jill Feldman, 41, didn’t need statistics to know she lived beneath ts menacing shadow. Orphaned at age 28 (both her parents died of lung cancer within months of diagnosis; her father was diagnosed at 41, her mother at 54), the Deerfield, Ill., mom of four also lost two grandparents and an aunt to the disease. “With such a strong family history, I feared a healthy lifestyle was not going to save me,” Feldman admits. In 2006, a CT scan (recommended by her doctor due to her family history) revealed a suspicious lesion on her right upper lobe, eventually diagnosed as adenocarcinoma—a lung cancer that proved to be more aggressive than doctors originally thought. Boyar says studies attribute a whopping 85 percent of lung cancer to smoking (it’s also the primary risk factor for pancreas, bladder, kidney, head and neck and esophageal cancer) and says individuals with a specific genetic mutation may have even more difficulty metabolizing cigarette smoke. “In families like Feldman’s, we’d say smoking, including secondhand smoke exposure, may be exceptionally toxic.” (Feldman smoked intermittently in high school and college but not enough to be considered a former smoker by her physicians.) Feldman’s surgeons removed the upper right lobe of her lung that contained the lesion, and she now considers herself cancer-free. To maintain that coveted status, she undergoes regular scans and blood work and takes a drug called Tarceva. She walks two to three miles, five days a week, to reduce her cancer risk and boost lung capacity, and has revamped her diet to include more whole grains, low-fat dairy, fruits and vegetables. “We eat a lot of broccoli,” she jokes. That’s smart snacking: Numerous studies have linked sulforaphane, a chemical found in broccoli, with reduced cancer risk. The lung cancer survivor also was an integral part of growing the grassroots nonprofit fundraising organization LUNGevity, which gave her “somewhere to focus my anger after all the losses,” she says. Bauer says Feldman may reap even greater rewards putting her energy into this kind of service: “A sense of empowerment is absolutely critical,” he notes. “My patients who take charge of their health care almost always do better.” And while Feldman wasn’t ultimately able to dodge the family disease, her outlook has certainly benefited from recognizing her risk and acting on it. “Catching a cancer early can mean all the difference,” notes Boyar. “If a person is aware of her family history, and that serves as a catalyst for seeking medical care she might not otherwise have sought, that’s a good outcome.” 

According to Kathryn Diemer, M.D., clinical director of the Bone Health Program at the Washington University School of Medicine in St. Louis, 70 percent of osteoporosis risk is determined by genetics. Still, “you’re not doomed,” she says. “Your job is to do anything you can to achieve peak bone mass and maintain it.” (That’s because women can lose up to 20 percent of their bone density in the five to seven years following menopause.) The good news: Bone is living tissue, just like muscle and skin, which means you can feed and strengthen it. Meeting your daily calcium and vitamin D needs is crucial for building and maintaining bone strength. “Calcium’s the building material of bones, like bricks in a brick wall,” explains Amy Joy Lanou, Ph.D., senior nutrition scientist for The Physicians Committee For Responsible Medicine and co-author of Building Bone Vitality (McGraw Hill). Vitamin D and 16 other nutrients provide the mortar, says Lanou. Women from ages 19 to 50 should aim for 1,000 milligrams of calcium per day (post-menopausal women need 1,200 milligrams). Be sure to incorporate calcium-rich foods into your diet, like low-fat Greek yogurt, leafy green vegetables and almond milk. While the National Institutes of Health recommends 200 IU of vitamin D per day, Diemer suggests five to 10 times that dose. “We’re seeing D deficiency in 70 percent of our patients, the result of wearing sunscreen and working indoors,” she says. A blood test can diagnose deficiency (optimum results should read 30 ng/mL or higher). Few foods provide vitamin D, but salmon, tuna, mackerel and UV-B lightboosted mushrooms (try Sun Bella) can help boost your level. Lanou says that when it comes to osteoporosis prevention, what you take out of the bone is just as important as what you put into it. Most modern diets are high in acidforming foods, such as meat, cheese and eggs, and lack adequate alkaline products, like fruits and vegetables. “In order to neutralize the acidity, the body pulls calcium compounds from the bone.” The result: Weaker, demineralized bones that are ripe for osteoporosis. If you’re worried about following in your mother’s frail footsteps, Lanou suggests limiting animal proteins, sodas, packaged foods and other acidic picks, and packing in six to nine daily servings of produce—prime advice for all of us. Weight-bearing exercise is also crucial. “You don’t need to run a marathon, just be up on your feet,” Diemer says. Walking, dancing and yoga all count. In addition to 20 minutes of weight-bearing cardio, three times per week, incorporate two 20-minute weightlifting sessions. Muscle exerts resistance on bones, strengthening them as they struggle to support the extra weight. Pilates works especially well for strengthening the spine and core; research presented at the 2010 American College of Sports Medicine annual meeting found a regular Pilates regimen increased spine and thigh bone density in middle-school girls, reducing their risk of osteoporosis later in life. That said, excessive exercise cripples bone health. “If you’re working out enough to lose your period, that means you’re not making enough estrogen to maintain bone mass,” says Diemer. Regardless of family history, all women should undergo a bone density scan when they reach 65 or finish menopause, whichever comes first. And even if you are diagnosed, today’s prognosis is much better than your mother’s: Current medications can lower your risk of fractures by as much as 70 percent. 

My prophylactic pursuit
In the months and years following my mom’s MS diagnosis, I felt almost resigned to a similar future. What I’m learning, though, is that my intense fretting might be wreaking far more havoc than any genetic risk. “While you’re spending a lot of time worrying about MS, your brain is responding as if someone were coming at you with a knife, jazzing up your adrenal glands and suppressing your immune system,” Bauer told me. In other words, my nerve-rattling anxiety has been laying down the red carpet not only for autoimmune disease, but cancer and heart disease, along with nuisances like migraines, ulcers and delayed wound healing. Besides bumping up my vitamin D intake, I’ve committed myself to downgrading my stress levels —a move Bauer recommends for anyone concerned about “inheriting” a chronic disease. That means integrating at least 30 minutes of meditation (in the form of breath work, Bikram yoga, reading poetry) into my daily routine. I’ll continue to work out five days a week and eat mostly whole, plant-based foods. And while Kalanick’s gluten-free recommendation makes sense, I’d need to see stronger research definitively linking such a big lifestyle change to autoimmune disease prevention before ditching bread and baked goods. In classic neurotic style, I asked Bauer if I now needed to worry about my years of worrying. He reassured me that while we all take health missteps, our bodies are incredibly resilient. It’s time to start focusing on my mom’s unbelievable grace and perseverance (her license plate reads “GTBCKUP”) and hope that those are the traits I inherited.