Nature vs Nurture: Why Family History is not Destiny
Though obtaining a family history is a part of a medical visit, it is actually not as important as you might think. In fact, I believe by placing too much emphasis on family history, we create a sense of helplessness in our patients. A better way to understand the impact family history has on our health is to remember the following statement:
Genetics loads the gun, but lifestyle pulls the trigger.
Take for instance the genes linked to breast cancer and ovarian cancer, known as the BRCA genes. BRCA genes are found in all humans and other mammals as well. They are involved in suppressing the formation of cancer in the breast and ovary and other organs. Some families carry a mutated version of the BRCA gene that prevents the gene from suppressing cancer. Some families have carried the mutated BRCA for generations. In other circumstances, a new mutation in the gene could arise de novo or in utero, that is at the moment of conception or during development in the uterus.
People who have a mutated or defective BRCA gene lose the ability to repair damage to their DNA. Damage to our DNA occurs every second of every day. Our bodies have many mechanisms in place to deal with damaged DNA. One such mechanism is ‘repair genes’ like BRCA. If BRCA isn’t working then damaged DNA leads to cancer initiation. A cancer cell starts to grow. Our bodies have another layer of protection against cancer involving our immune system, bolstered by antioxidants in our diets. Just like our immune system fights bacterial and viral invaders, it also seeks and destroys small cancer cells.
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Think of it like small brush fires that start in several places but are easy to keep under control. Now if you pour gasoline on one of these small brush fires causing it to grow rapidly, our second layer of defense, our immune system is overwhelmed and can’t stop it. The gasoline on the brush fire promotes the fire. Small clusters of cancer cells that are given a promoter will also start to grow fast, overwhelming our second lines of defense.
Cancer promoters include smoking for lung cancer and HPV infections for cervical cancer. The promoter for breast and ovarian cancer includes a high fat, Western diet, lacking in greens and whole grains. This is why Eastern European families with the BRCA mutation had lower rates of breast cancer while they were in Eastern Europe than when they migrated to the United States. Same gene mutation, different levels of cancer promoters.
Given this, family history does not mean as much as we like to think. Whether or not we carry some predisposition to cancer initiation does not mean we cannot prevent cancer promotion, literally nipping cancer in the bud, putting out the small brush fires. Our energy and focus should be placed on avoiding cancer promoters. Eating a low oil, whole grain, plant-based diet is your surest bet!
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