Guidelines for Providers: Referral to genetic counseling for family history of cancer

Approximately 10% of all cases of cancer are hereditary, and may be traced to inherited mutations in specific genes. Diagnosing hereditary cancer syndromes is essential to proper medical management for patients at higher risk.

When taking a family history, it is important to document the primary location and age of onset of all known cases of cancer in first- and second-degree relatives.

Signs of hereditary cancer in a family history:

1. Early onset (pre-menopausal breast cancer, colon cancer in the 30’s-40’s).
2. Three or more cases of the same type of cancer in a 3-generation history.
3. Rare cancers, such as male breast cancer, childhood sarcoma, retinoblastoma.
4. Ashkenazi Jewish ancestry with breast, ovarian or colon.
5. Genetically-related tumors in the same family or individual, such as: a. breast/ovarian,
   b. colon/endometrial/ovarian/gastric,
   c. breast/thyroid/endometrial/melanoma,
   d. breast/colon
   e. breast/brain/colon/osteosarcoma/acute leukemia
   f. parathyroid/pituitary/GI sarcoid
   g. medullary thyroid/pheochromocytoma
   h. diffuse gastric/lobular breast
   i. clear cell renal/pheochromocytomas/retinal angiomas