Risk Assessment

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UK population risk for breast cancer - 1 in 10

Ovarian cancer - 1 in 70

Bowel Cancer 1 in 25

Several family members with same cancer

Family members with the same rare cancer

Early age of presentation

Unusual presentation (male breast cancer)

Bilateral tumours

Multifocal tumours - multiple cancers (e.g. in breast)

Synchronous tumours - tumours in more than 1 different organ

Successive tumours

Ethnic origin (e.g. Ashkenazi Jewish)

Precancerous condition (ductal carcinoma in situ, adenomatous polyps)

Ovarian WITH breast

Endometrial WITH bowel

Cervical 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