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
- Presence of certain cancers
Ovarian, pancreatic, triple negative (ER-/PR-/Her2-) breast, male breast, metastatic or high grade (Gleason >7) prostate cancer are suggestive of a hereditary predisposition.
- Early age of onset
The average age for breast cancer diagnosis is > 50 years. Breast cancer ≤ 50 years suggests an underlying susceptibility.
- Multiple affected relatives
Two or more close relatives* with the same or related cancers suggests a hereditary predisposition, especially when in consecutive generations.
- Bilateral or multifocal disease
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.
- Disease in the absence of known risk factors or 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.
* Close relatives include parents, children, siblings, grandparents, aunts/uncles and first cousins.
+HBOC-related cancers include breast, ovarian, prostate, melanoma and pancreatic.
Colorectal Cancer Genetic Red Flags
- Early age of onset
The average age for colon cancer (CRC) diagnosis is > 50 years. Early-onset cancer or adenomatous polyps < 50 years suggests an underlying susceptibility.
- Multiple affected relatives
Two or more close relatives* with the same or related cancers+ suggests a hereditary predisposition, especially when in consecutive generations.
- 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.
- Other notable history
Certain non-cancer findings can be suggestive of a hereditary syndrome that includes CRC. Some features include osteomas, sebaceous cysts, desmoid tumors, spots on the retina (CHRPE), extra teeth, birth defects, intellectual disability.
*Close relatives include parents, children, siblings, grandparents, aunts/uncles and first cousins.
+Lynch syndrome-related cancers include: colon, rectal, endometrial, gastric, ovarian, pancreas, ureter and renal pelvis, brain (usually glioblastoma), biliary tract, small intestinal cancers, as well as sebaceous skin lesions and keratoacanthomas.