High-Risk Management

The field of genetics is growing at a rapid pace, making it important to keep in touch with a UT Southwestern genetics expert. The discovery of new genes, development of new technology, or changes to your personal and/or family history may impact genetic testing/management options in the future.

Use the table below as a guide for when to contact us: 

Contact your genetic counselor …

When?

Why?

To see if updated genetic testing becomes available, even if nothing has changed

Every one to two years

Testing for a newer gene could help understand reasons for cancer in a family

If your family history has changed

Immediately

This could change cancer screening or genetic testing options

To see if cancer screening recommendations have changed

Every one to two years

New options could help prevent or detect cancers earlier

To update your contact information

Immediately

We send follow-up information or important changes over time


Family History of Colorectal Cancer

The National Comprehensive Cancer Network (NCCN), American Gastroenterology Association (AGA), American Cancer Society (ACS), and others publish colon cancer screening recommendations based on increased risk due to family history or personal risk factors (NCCN - Colorectal Cancer Screening v1.2015, AGA 2008, ACS 2015).

These recommendations are based on the number of first- (siblings, children, parents) or second- (aunts/uncles, grandparents, nieces/nephews) degree relatives diagnosed with colon cancer and their ages at diagnosis. A first-degree relative with an advanced adenoma (polyp) is also a consideration for changing colonoscopy screening recommendations. Individuals at an increased risk should discuss this information with their physicians to establish an appropriate screening routine.

Risk factors such as a history of colon polyps, including the number of polyps (as well as the type and size of polyps) or a history of inflammatory bowel disease (ulcerative colitis, Crohn’s disease) can affect the age when someone should start screening, and how often they should be screened. 

Family History of Breast Cancer

The American Cancer Society (ACS), National Comprehensive Cancer Network (NCCN), United States Preventative Task Force (USPSTF), and others recommend high-risk screening or risk-reduction options for women with a calculated lifetime breast cancer risk that is greater than 20 percent (average breast cancer risk for women is 13 percent). For women with a five-year risk of greater than 1.67 percent, risk reduction options may also be considered.

The lifetime risk estimation is based on family history and personal risk factors, and this can be calculated using a variety of risk assessment models. Talk to your doctor or genetic counselor about your risk based on your personal and family history, and they can use the risk assessment models (Claus, Gail, Tyrer-Cusick, BRCApro, and others) to calculate your personal breast cancer risk. 

Options can include:

  • Surgery (risk-reducing bilateral mastectomy, or removal of both breasts preventatively)
  • High-risk screening and medication options
  • Screening options, including using breast MRI in addition to annual mammogram
  • Medications such as Tamoxifen, which can be used to decrease breast cancer risk in patients who qualify

All of these options should be discussed with your doctor.

Family History of Other Cancers

Family history of any cancer should be discussed with your personal physician to determine if cancer screening recommendations should be changed. National guidelines typically recommend starting cancer screening five to 10 years before the earliest cancer in a close relative (such as sibling/parents).