Tough topic, but let's talk. Routinely I get calls, emails, even office consults about marriage. Typically, at least in the Persian Jewish community, a parent is worried that his or her son or daughter is marrying someone who has a risk of carrying a gene for heart disease, cancer, mental illness, neurologic diseases. I'm often frustrated by the line of questioning. "I want a guarantee that my grandchildren don't end up with cancer/ mental illness like these people have in their family..." My comments. 1- If there is one guarantee in life, it's that people will get sick and die. The top two most common killers are heart disease and cancer. So, you work out the chances! 2- What diseases do you carry in your side of the family? This truth, which they have ignored up to now because everyone likes to believe they are perfect, hits them like an insult. 3- Most diseases are now manageable- even if it's highly genetically penetrable and in a first degree relative- such as a BRCA Positive breast cancer in her mom. She can be tested and if positive, have proper genetic counseling. 5- Most cancers are not caused by genetics, but by bad luck. You cannot avoid marriage to avoid cancer! 6- Some neurologic conditions, such as Tay-Sachs or Inclusion Body Myopathy can be tested and genetic counseling given to avoid sick offspring. Increasingly, genetic testing of the fetus along with highly accurate 3/4D ultrasounds can assure parents of the health of the fetus at birth. 7- You can order tests like Color.com or formal blood/genetic tests available for the following conditions and many others: Cancer including breast, ovarian, colon, pancreas, thyroid, skin, sarcoma, brain, prostate, uterus, bladder, kidney, stomach, pheochromocytoma and others; Movement Disorders like Huntington disease, Parkinson disease, dystonia and spinocerebellar ataxias; Cardiac Disease including long QT syndrome, certain cardiomyopathies and dyslipoproteinemias and others; Muscular Dystrophies like Duchenne muscular dystrophy, Becker muscular dystrophy and myotonic dystrophy; Blood Disorders including hemophilia, inherited thrombophilias (e.g., factor V Leiden), sickle cell disease, alpha and beta thalassemias and others; Known Genetic Conditions like neurofibromatosis, Marfan syndrome, hemochromatosis, polycystic kidney disease and cystic fibrosis. These tell you risks but not whether you should marry someone or not. 8- Most people show up for counseling after they have fallen in love, just before marriage, and at the hands of the parents who wish to have a guarantee for life. There is no guarantee. I can hardly think of anyone that should break up because of genetics. 9- So many challenges happen in a marriage that a strong bond should never be broken over potential genetics. The important point is a good working relationship that can help the couple deal with problems should they arise. Most cancers and other health diseases CANNOT be avoided. We all come with a set of problems. If you break up because of potential genetics, you are trading one set of potential problems for another set of potential problems which become much, much larger if there is no real love! 10- In the end, finding the right person is difficult enough. You are not breeding racehorses! You are looking for love and once there is true love, all else can be worked out.
