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Tables
- Table 1.
Identification and Management for Patients at Increased Risk of Breast Cancer based on Family Cancer History
Identification of persons at ‘increased risk’ because of family cancer history Breast cancer risk increased among: Women with a mother and/or sister(s), daughter(s) with breast cancer, especially if diagnosed before age 50 years. Women who have a father and/or paternal relatives (grandmother or aunts) with breast cancer, especially if diagnosed before age 50 years. Women who have maternal relatives (grandmother or aunts) with breast cancer, especially if diagnosed before age 50 years. Families with a history of breast and/or ovary and/or colon and rectum cancers among mothers/fathers, brothers/sisters, children, and/or maternal or paternal relatives. Families with a history of cancers and/or inherited conditions or known/suspected gene mutation associated with breast cancer risk (eg, BRCA1/2 mutations, Li Fraumeni syndrome, Ashkenazi Jewish ancestry). Surveillance recommendations for persons at ‘increased risk’ because of family cancer history Beginning at age 30 years (or 10 years before age of earliest case in family): Evaluate family history of cancer and overall health status of patient. Discuss risk status and overall health status with patient and plans for ongoing surveillance, including age to begin mammography. Consider whether involvement in a prevention trial is an option. Consider a consultation with a genetic counselor for risk assessment and possible genetic testing. - Table 2.
Identification and Management for Patients at Increased Risk of Ovarian Cancer Based on Family Cancer History
Identification of persons at ‘increased risk’ because of family cancer history Ovarian cancer risk increased among: Women who have a mother and/or sister(s), daughter(s), or grandparent(s) with breast cancers and/or ovarian cancers, especially if one or more is diagnosed before age 50 years. Women with a personal or family history of breast, endometrial, or colorectal cancer. Surveillance recommendations for persons at ‘increased risk’ because of family cancer history All ages: Evaluate comprehensive family history of cancer and overall health status of patient. Discuss risk status, and overall health status with patient, and plans for ongoing surveillance including possible referral to specialist, ultrasound monitoring, pelvic examination and CA-125 testing. Consider whether involvement in a prevention trial is an option. Consider a consultation with a genetic counselor for risk assessment and possible genetic testing. - Table 3.
Identification and Management for Patients at Increased Risk of Colorectal Cancer Based on Family Cancer History
Identification of persons at ‘increased risk’ because of family cancer history Colorectal cancer risk increased among: Persons who have an FDR with cancer of the colon or rectum. Persons who have a maternal or paternal relative (aunt/ uncle, grandparent) with colorectal cancer, especially if diagnosed before age 50 years. Persons with a personal and/or family history of inherited conditions associated with colon cancer (eg, HNPCC and FAP). Families affected by cancers of the uterus, breast, and/ or ovary among first-degree or second-degree relatives (consider consultation with a genetic counselor/specialist). Surveillance recommendations for persons at ‘increased risk’ because of family cancer history Beginning at age 40 years (or 10 years before age of earliest case in family): Evaluate comprehensive family history of cancer and overall health status of patient. Discuss risk status, and overall health status with patient, and plans for ongoing surveillance including age at which to begin colonoscopy and plan for ongoing surveillance. Persons who have a mother, father, or sibling who has been diagnosed with colorectal cancer, require a colonoscopy at age 40 years, or earlier, depending upon age of onset in the family. Persons at increased risk of colorectal cancer require colonoscopy; no other test may substitute. Consider a consultation with a genetic counselor for risk assessment, and possible genetic testing. Consider whether involvement in a prevention trial is an option. HNPCC, hereditary nonpolyposis colorectal cancer; FAP, familial adenomatous polyposis; FDR, first-degree relative.
- Table 4.
Identification and Management for Patients at Increased Risk of Prostate Cancer Based on Family Cancer History
Identification of persons at ‘increased risk’ because of family cancer history Prostate cancer risk increased among: Men who have a father, brother, or son with cancer of the prostate. Men with a mother or sister who has been diagnosed with ovarian cancer. Families with a history of breast and/or ovarian cancer(s) among first-degree or second-degree relatives may be at increased risk (consider consultation with a genetic counselor/specialist). Surveillance recommendations for persons at ‘increased risk’ because of family cancer history Beginning at age 40 years (or 10 years before age of earliest case in family): Evaluate comprehensive family history of cancer and overall health status of patient. Discuss risk status and overall health status with patient and plans for ongoing surveillance, including possible PSA testing starting at age 40 years, or earlier, depending upon age of onset in the family (be certain to discuss the risks and benefits of PSA testing and plan for ongoing surveillance). Consider a consultation with a genetic counselor for risk assessment. Consider whether participation in a prevention trial is an option. PSA, prostate-specific antigen.
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