Cancer in the family

Moderately increased risk: Offer mammography every 2 yrs for women 50-69 yrs. Women aged 40-49 yrs are also eligible for free mammography. Mammographic screening is not recommended for women younger than 40 yrs.

1. One 1° relative diagnosed with breast cancer before the age of 50; or
   
2. Two 1° relatives, on the same side of the family, diagnosed with breast cancer; or
   
3. Two 2° relatives, on the same side of the family, diagnosed with breast
   cancer, at least one before the age of 50.

Potentially high risk: Refer to a familial cancer service or to Genetics Services.

1. A women at potentially high risk for breast cancer; or
   
2. One 1° relative diagnosed with epithelial ovarian cancer in a family of Ashkenazi Jewish ancestry; or
   
3. One woman with ovarian cancer at any age, and another with breast cancer before the age of 50, where the women are 1° or 2° relatives of each other; or
   
4. Two 1° relatives, on the same side of the family, diagnosed with ovarian cancer especially if one or more of the following features occurs on the same side of the family:
5. Additional relative(s) with breast or ovarian cancer
   
6. Breast cancer diagnosed before the age of 40 yrs
   
7. Bilateral breast cancer
   
8. Breast and ovarian cancer in the same woman
   
9. Breast cancer in a male relative; or
10. Three or more 1° or 2° relatives on the same side of the family diagnosed with any cancers associated with hereditary non polyposis colorectal cancer: colorectal cancer, endometrial cancer, ovarian cancer, gastric cancer, and cancers involving the renal tract; or
11. A woman suspected to have HNPCC (see Cancer in the Family); or
    
12. Member of a family in which a high risk ovarian cancer gene has been established.

Moderately increased risk: Offer colonoscopy every 5 yrs starting at age 50, or at an age 10 yrs younger than the age of first diagnosis of colorectal cancer in the family, whichever comes first. Flexible sigmoidoscopy plus double contrast barium enema or CT colonography may be offered if colonoscopy is contraindicated for some reason. Consider offering FOBT in the intervening yrs.

1. One 1° relative with colorectal cancer diagnosed before the age of 55; or
   
2. Two 1° or one 1° and one 2° relative(s) on the same side of the family with colorectal cancer diagnosed at any age.

Potentially high risk: Refer to a familial cancer service or to Genetics Services.

1. A woman at potentially high risk for ovarian cancer; or
2. Two 1° or 2° relatives on the same side of the family diagnosed with breast or ovarian cancer, plus one or more of the following features occurs on the same side of the family:
3. Additional relative(s) with breast or ovarian cancer
   
4. Breast cancer diagnosed before the age of 40 yrs
   
5. Bilateral breast cancer
   
6. Breast and ovarian cancer in the same woman
   
7. Breast cancer in a male relative
   
8. Ashkenazi Jewish ancestry; or

Potentially high risk: Refer to a familial cancer service or to Genetics Services.

1. Three or more 1° relatives or a combination of 1° and 2° relatives on the same side of the family diagnosed with colorectal cancer; or
   
2. Two or more 1° or 2° relatives on the same side of the family diagnosed with colorectal cancer, plus any of the following features:
3. Multiple colorectal cancers in a family member
   
4. Colorectal cancer before the age of 50
   
5. A family member who has/had an HNPCC-related cancer (endometrial, ovarian, stomach, small bowel, renal pelvis or ureter, biliary tract, brain cancer); or
6. At least one 1° or 2° relative with a large number of adenomas throughout the large colorectum; or
   
7. Member of a family in which a high risk colorectal cancer gene has been established.