Cancer Red Flags Checklist

General cancer genetic red flags that indicate increased or high risk

Genetic red flags are features of the personal or family medical history that may suggest a higher than average genetic contribution to cancer risk. These are unusual presentations of cancer that are more likely when a genetic variant is present from birth. Use this resource with the Cancer Genetic Risk Assessment tool.

  • presence of certain cancers
  • early onset cancer or adenomatous colon polyps
  • multiple relatives with the same or associated cancers on the same side of the family
  • bilateral or multifocal disease
  • individual with greater than 10 adenomatous colon polyps
  • disease in the absence of known risk factors
  • ethnic predisposition
 
 

Breast cancer genetic red flags

+ or -

 Red Flag
Explanation
Description

 Early age of onset

 

 The average age for breast cancer diagnosis is > 50 yrs. Pre-menopausal breast cancer suggests an underlying susceptibility.  

Bilateral disease/multiple primaries

 

 Although a tumor may metastasize, it is rare to have more than one primary cancer. Bilateral breast cancer, or breast and ovarian cancer in the same person suggest a predisposition.  

 Male breast cancer

 

 Breast cancer is rare in males, and when it occurs, suggests a hereditary susceptibility.  

 Ovarian cancer

 

 Ovarian cancer is rare except with a hereditary predisposition. A history of ovarian cancer is alone indication for further evaluation for HBOC.  

 Multiple affected relatives

 

 Two or more close relatives* with the same or related cancers suggests a hereditary predisposition, especially when in consecutive generations.  

 Disease despite preventative measures

 

 Some interventions like oophorectomy lower the risk for breast and ovarian cancer. If cancer occurs anyway, preexisting susceptibility is more likely.  

 Ashkenazi Jewish ancestry

 

 1 in 40 individuals of Ashkenazi ancestry carries a mutation in either the BRCA1 or BRCA2 gene.  

Other notable history

 

 Unusual physical features, birth defects, intellectual disability or other notable family history may indicate a different genetic syndrome. Discuss these with a genetics professional.  

*Close relatives include parents, children, siblings, grandparents, aunts/uncles and first cousins.

+HBOC-related cancers include breast, ovarian, prostate, melanoma and pancreatic.

Download the checklist.

Colorectal cancer genetic red flags

+ or -

 Red Flag
Explanation
Description

 Early age of onset

 

 The average age for colon cancer (CRC) diagnosis is > 50 yrs. Early-onset cancer suggests an underlying susceptibility.  

Multiple primaries

 

 Although a tumor may metastasize, it is rare to have more than one primary cancer. CRC more than once, or CRC and an additional related cancer+ in the same person suggests a predisposition.  

 Multiple colon polyps

 

 10 or more adenomatous colon polyps suggests an underlying hereditary predisposition.  

 Rare types of polyps

 

Unusual pathology of polyps may be suggestive of a hereditary syndrome.  

 Multiple affected relatives

 

 Two or more close relatives* with the same or related cancers+ suggests a hereditary predisposition, especially when in consecutive generations.  

Other notable history

 

Osteomas, sebaceous cysts, desmoid tumors, spots on the retina (CHRPE), and extra teeth can be associated with a hereditary form of CRC. Other unusual physical features, birth defects, intellectual disability or other notable family history may indicate a different genetic syndrome. Discuss these with a genetics expert.  

+Lynch syndrome-related cancers include: colorectal, endometrial, gastric, ovarian, pancreas, ureter and renal pelvis, biliary tract, glioblastoma, small intestinal, sebaceous gland and keratoacoanthomas

*Close relatives include parents, children, siblings, grandparents, aunts/uncles and first cousins