Inherited Cancer in India: Why Family History Alone Isn't Enough Anymore

Cancer Is Rising, but Prevention Can Start Earlier

Cancer is now one of the major health problems we are facing. In today's world, nearly every family has somebody who has fought the disease. Even though there is a great deal of talk about lifestyle factors such as smoking, obesity, unhealthy diets, and pollution, there is one thing about cancer which still does not get the attention it should in India and that is inherited cancer.

It is commonly thought that once someone knows their family's medical history they have all the information they need regarding their own risk of developing cancer. However, although family history is still a valuable piece of evidence, it is no longer sufficient on its own. Due to progress in genetic science we now know that our DNA can show us risks which cannot be detected merely from looking at family history. As a result, doctors' methods of dealing with cancer prevention are being altered around the world.

The World Health Organization states that in 2022 cancer resulted in about 20 million new cases and 9.7 million deaths worldwide, which means it is one of the main causes of death on a global scale. In India there is a gradual increase in the number of cancer cases, and it is expected that the burden will keep growing during the next ten years. Since the problem is becoming more severe, prevention and early risk assessment have become just as important as treatment.

A key point that people should know is that there is no guarantee that all cancers are inherited; in reality, approximately 5 to 10 per cent of all cancers are associated with inherited genetic changes which are transmitted from one generation to the next. Although this seems to be a minor proportion, it can make a big difference to identify such individuals since they usually have a much greater lifetime risk of getting certain cancers.

It is here that many families inadvertently commit an error. They think that since no member of the family has had cancer they are entirely safe. Unluckily, that is not always the case.

Understanding Inherited Cancer Risk

Family histories are sometimes incomplete since the people in earlier generations may not have been properly diagnosed; medical records might not have been kept. Some relatives could have died before they even received a diagnosis. In many Indian families, illness was never spoken about openly, particularly amongst women. There are also cases in which inherited genetic changes originate in the father's family but are ignored since breast and ovarian cancers are generally believed to be linked only with women.

That is why depending solely on family history may lead to a false sense of reassurance.

Now, genetic testing enables us to move beyond mere assumptions; rather than simply finding out which members of the family had cancer, we can check whether an individual has certain inherited genetic changes that raise their lifetime risk of cancer.

The BRCA1 and BRCA2 genes are probably the most well-known. They play a role in repairing damaged DNA within our cells. If these genes have harmful inherited mutations, the body's capacity to repair DNA is lowered and this raises the chance of developing cancers including breast, ovarian, prostate, pancreatic, and a number of other types. The US National Cancer Institute states that women with harmful BRCA mutations have a greater than 60 percent lifetime risk of breast cancer, as compared to about 13 percent in the general population.

It is not the case that genetic testing can be used to predict with certainty that someone will develop cancer; that is one of the greatest myths associated with genetics.

A positive result of a genetic test only indicates that a person has an increased risk, not that the risk is certain. More significantly, it offers the chance to take preventive measures. On the basis of the individual's risk profile, doctors might suggest earlier screening, more frequent monitoring, changes to one's lifestyle, or preventive medical treatments. Often, detecting cancer in its early stages results in better treatment outcomes and greatly enhances survival.

What are the actions that individuals and families should take?

As genetic awareness grows, experts recommend a few simple but important steps:

• Make sure you know your family history by keeping a record of all the cases of cancer that have been diagnosed in your parents, siblings, grandparents, aunts, and uncles, noting the age at which each diagnosis was made.
• Early onset cancers should not be ignored. If several members of your family have developed breast, ovarian, colorectal, pancreatic, or prostate cancer, in particular if this occurred before the age of 50, you should see a specialist.
• It is advisable to obtain genetic counselling when it is appropriate; a qualified genetics specialist will be able to decide if genetic testing is necessary, suggest the suitable test, and assist with the correct interpretation of the results.
• It must be remembered that having a genetic risk does not amount to a diagnosis; a positive result indicates an increased risk, not a certainty. It enables doctors to suggest personalised screening, preventive measures, and timely medical interventions.
• Promote open discussions within families, since passing on one's medical history from one generation to another can help in detecting inherited risks at an early stage and allow other family members to take preventive action.

The discussion concerning inherited cancer is particularly relevant in India since we are now witnessing more cases of cancer being diagnosed in younger people. In many instances, these patients have no evident lifestyle risk factors. It is for this reason that understanding inherited genetic risk becomes even more important.

The way healthcare is developing is moving slowly from curing diseases after they have occurred to spotting risks before they turn into illnesses. Nowadays, we use tests for blood sugar to assess the risk of diabetes and tests for cholesterol to evaluate the risk of heart disease. Genetic testing is also emerging as a powerful means of aiding preventive healthcare.

We have always held at Seeds of Innocence that improved healthcare starts with better information; even though we are widely known for having helped thousands of couples reach parenthood through our advanced fertility care, we also realise that genetics has a much bigger role throughout a person's life.

The fact that we have a dedicated in-house genetics laboratory led to the foundation of Genestring Labs. Since it is one of the very few fertility healthcare groups in India to have an integrated genetics laboratory, Seeds of Innocence allows patients to receive fertility care together with specialised genetic testing within the same clinical environment. This way of working enables fertility specialists and genetic experts to collaborate closely and ensures that genetic results are understood in the light of each patient's full health rather than being treated as separate laboratory reports.

Genestring Labs provides thorough genetic testing in a number of areas, including hereditary cancer, reproductive genetics, prenatal testing, newborn screening, inherited disorders, and personalised medicine. The laboratory uses advanced technologies such as Next Generation Sequencing, microarray analysis, and Sanger sequencing and combines cutting-edge diagnostic capabilities with expert genetic counselling in order to help both patients and clinicians reach informed decisions about their healthcare.

With increasing awareness of inherited cancers, attention should move away from merely treating the disease to detecting the risk as early as possible and giving families the knowledge they need to make informed decisions before symptoms show.

Preventing cancer is not simply a matter of leading a healthier lifestyle any longer; for certain families it also involves understanding what their genes might be attempting to communicate.

Family history will always remain an important starting point, but nowadays science enables us to go a stage further. Genetic testing helps to overcome the gaps which family history cannot, giving individuals and families a more clear view of their health risks.

Because when it comes to inherited cancer, gaining earlier knowledge doesn't merely offer information.

It gives the chance to take action, to get ready, and in many cases to save lives.

About the Author

Gauri Agarwal founded and is the Managing Director of Seeds of Innocence IVF, Home IVF, and Genestring Labs. As a pioneer in the field of reproductive medicine and genetics, she has played a key role in developing fertility care, preventive genomics, and patient-centred healthcare in India. By using an integrated method which combines fertility treatment with advanced genetic diagnostics, she is determined to assist families in making informed decisions regarding their healthcare and in improving their long-term health outcomes.