Risk Assessment

UK population risk for breast cancer - 1 in 10Ovarian cancer - 1 in 70Bowel Cancer 1 in 25

Several family members with same cancerFamily members with the same rare cancerEarly age of presentationUnusual presentation (male breast cancer)Bilateral tumoursMultifocal tumours - multiple cancers (e.g. in breast)Synchronous tumours - tumours in more than 1 different organSuccessive tumoursEthnic origin (e.g. Ashkenazi Jewish)Precancerous condition (ductal carcinoma in situ, adenomatous polyps)Ovarian WITH breastEndometrial WITH bowelCervical and lung cancer can normally be disregarded (environmental)Male breast cancer 10% due to BRCA2

three generation pedigree Proband's health history - age, previous cancers, (for B/O age at menarche, age at first pregnancy, number of children, OCP use, age at menopause, use of HRT), history of risk reducing surgery If affected - age at diagnosis, year of diagnosis, details of hospital treated at, tumour pathology, cancer treatment (e.g. chemotherapy), any hormonal treatment (e.g. tamoxifen) Access histology reports, cancer registry, death certificates (requested by proband/relative), clinical notes to confirm diagnoses - consent needed from living indvs or if dead, living relative **Factors that make a pedigree hard to interpret: small family size, non-paternity, fertility treatment, adoption, removal of at-risk organs, estrangement, late or variable onset, non-penetrance, variable expression, de novo mutations, mosaicism, consanguinity, 

population risk

Warning signs

GC actions