Family History and Lung Adenocarcinoma Risk Factors

Questions about lung adenocarcinoma?

I have several questions for the doctor.

1.
What is the definition of family medical history? If there is only one case of a relative having a condition and no one else in the family has it, does this still fall under the medical definition of hereditary conditions, or is it considered a spontaneous mutation? I have a relative (a third-degree relative) who was recently diagnosed with stage IV lung adenocarcinoma at the age of 65, but most other relatives have lived long lives without this issue.
Does this count as hereditary? This relative has been a heavy smoker for over 40 years.
2.
If it is considered hereditary, does this mean that we, as relatives, have an increased risk? There have been reports indicating that lung cancer can be hereditary, and that the risk may be significantly elevated.
Should we consider getting screened?

Niming, 30~39 year old female. Ask Date: 2019/10/03

Dr. Yang Wenda reply Pulmonology

1.
The cause of cancer remains unclear, but the primary culprit is carcinogens, especially smoking.
If a second-degree relative has lung cancer, there has been exposure to secondhand smoke, or there has been long-term exposure to other carcinogens in the workplace, and the individual is over sixty years old, the risk may be slightly higher.
It is recommended to have at least an annual chest X-ray examination.

2.
Most of your relatives have lived long lives, and only this third-degree relative who smoked has lung cancer.
We still believe that smoking is the main cause of lung cancer and that it is unrelated to genetics.
This is just my personal opinion for your reference!

Reply Date: 2019/10/03

More Info

Understanding family history and its implications for lung adenocarcinoma risk is a complex topic that intertwines genetics, environmental factors, and lifestyle choices. In your case, you are inquiring about the significance of a single family member diagnosed with stage IV lung adenocarcinoma and whether this constitutes a family history of cancer, particularly in the context of your other relatives who are generally healthy and long-lived.

1. Definition of Family History in Cancer: In medical terms, family history of cancer typically refers to the occurrence of cancer in first-degree relatives (parents, siblings) or second-degree relatives (grandparents, aunts, uncles). A single case of lung adenocarcinoma in a third-degree relative (like a cousin) does not usually meet the criteria for a significant family history of cancer. However, it is essential to consider the overall context, including the age of onset, the type of cancer, and any other familial patterns. The fact that your relative has been a heavy smoker for over 40 years is a critical factor, as smoking is the leading cause of lung cancer and may overshadow genetic predispositions.

2. Genetic vs. Environmental Factors: While certain genetic mutations can increase the risk of lung cancer, the majority of lung adenocarcinoma cases are influenced more by environmental factors, particularly smoking. The presence of lung cancer in a relative who has a significant smoking history may not necessarily indicate a hereditary risk for other family members. Instead, it highlights the environmental risk factors that could affect individuals with similar lifestyles.

3. Increased Risk and Screening Recommendations: If there is a concern about family history, it is prudent to consider individual risk factors, including personal smoking history, exposure to secondhand smoke, and other environmental exposures. Although the presence of lung cancer in a distant relative may not significantly elevate your risk, it is still wise to be vigilant about lung health, especially if you have other risk factors.
The general recommendation for lung cancer screening is a low-dose computed tomography (LDCT) scan for individuals aged 50-80 years who have a significant smoking history (defined as a 20 pack-year smoking history). If you or any close relatives have a history of heavy smoking, discussing screening options with a healthcare provider is advisable.

4. Genetic Counseling: If there are concerns about hereditary cancer syndromes, particularly if multiple family members across generations are diagnosed with various cancers, genetic counseling may be beneficial. Genetic counselors can assess family history, discuss potential hereditary cancer syndromes, and recommend genetic testing if appropriate.

5. Conclusion: In summary, while a single case of lung adenocarcinoma in a third-degree relative does not constitute a significant family history of cancer, it is essential to consider the broader context of lifestyle and environmental factors. If you have personal risk factors or concerns, discussing them with a healthcare provider can help determine whether further screening or preventive measures are warranted. Regular check-ups and awareness of any changes in health are crucial for early detection and intervention.

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