Genetic Red Flags Checklist

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


+ or -

 Red Flag

 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.