Table 1.

Screening Recommendations for Individuals with a Family History of Selected Cancers

Cancer	Risk Group	Screening Recommendation
Breast Cancer (6,7)	Average Risk	Annual screening mammography starting at age 40; Clinical breast exam (CBE) q3yrs at age 20-39 then annually starting at age 40; Breast self exam (BSE) starting at age 20
	Greater than 20% lifetime risk according to family history based model	All of the above PLUS Annual screening MRI
	Personal or family history of HBOC or other genetic syndrome known to increase breast cancer risk	Mammography beginning at age 25 OR 10 years prior to youngest age at diagnosis in family (whichever is sooner); Annual screening MRI; Annual CBE and BSE
	History of radiation to the chest wall (i.e., for Hodgkin Lymphoma)	As above but beginning screening at age 40 or 8-10 yrs after radiation treatment (whichever is sooner)
Colon Cancer (8)	Average Risk	Begin screening at age 50 years with colonoscopy (preferred), CT (virtual) colonoscopy, flexible sigmoidoscopy, FOBT, or double contrast barium enema; identified polyps should be removed
	Individuals found to have polyps on screening	<2 polyps, <1cm: repeat colonoscopy every 5 years Advanced or multiple adenomas: repeat exam within 3 years >10 adenomas: consider genetic syndrome
	Personal history of endometrial or ovarian cancer at age <60	Begin colonoscopy at age 40; repeat at least every 5 years (sooner if abnormal findings)
	Inflammatory bowel disease	Begin colonoscopy 8-10 years after onset of symptoms; repeat every 1-2 years
	One or more first-degree relative with colon cancer; two or more second-degree relatives with colon cancer	Consider genetics evaluation; begin screening at age 40; screen every 1-5 yrs depending on magnitude of family history
	Known HNPCC	Begin screening at age 20-25 or 10 years prior to youngest diagnosis in family; screen every 1-2 yrs; consider colectomy if not amenable to endoscopic polypectomies; consider prophylactic hysterectomy and/or oophorectomy
	Known FAP	Proctocolectomy or colectomy; annual sigmoidoscopy if retained rectum
Prostate Cancer (9,10)	Average risk	Annual prostate-specific antigen (PSA) testing and digital rectal exam (DRE) should be offered to men with at least a 10-year life expectancy, beginning at age 50
	African-American men or men with one or more first degree relatives diagnosed at age<65	Offer annual screening beginning at age 45
	Men with multiple first degree relatives affected at an early age	Could offer screening beginning at age 40; if first test is normal may not need to screen annually until age 45
Melanoma (11)	Average risk	Currently no evidence to suggest benefit for routine screening
	Family or personal history of melanoma	Head-to-toe skin examination every 6-12 months starting at age 10; Consider clinical photographs or epiluminescence microscopy; Encourage monthly skin self-examination; Excise of any suspicious or changing pigmented lesions; Education regarding sunburn avoidance and characteristics of suspicious lesions