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As a family practitioner YOU are the first line of defense for your patients.

Up to 10% of patients in your practice with a personal and/or family history of cancer may be at risk for developing breast, ovarian, colon and other cancers.1

Knowing your patient’s cancer family history can help you prevent cancer by identifying those appropriate for genetic testing. Myriad myRisk hereditary cancer test provides you with clear and actionable recommendations for managing patients with either positive or negative genetic results. Based on these results you and your patients can feel confident developing personalized plans for cancer prevention.



Learn more about myRisk Hereditary Cancer Testing and how to identify the patients in your practice at risk.

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Facts to Know:

  • UP TO
    10%
    of your patients may be at risk of developing a hereditary cancer
  • Clear screening guidelines are in place to identify patients appropriate for Hereditary Cancer Testing
  • 97% of private insurance covers testing
  • Testing can be done through a simple saliva sample
Click the tabs to learn more about the following:

Approximately seven percent of breast cancer cases are caused by mutations in the BRCA1 or BRCA2 genes.2

People who carry a mutation in either of these genes have a condition called Hereditary Breast and Ovarian Cancer (HBOC) syndrome.3-4

They have up to an 87% risk of developing breast cancer by age 70. In addition, mutation carriers who have already been diagnosed with cancer have a significantly increased risk of developing a second cancer in the future.

Myriad offers genetic testing that can be used to identify people who carry a BRCA1 or BRCA2 gene mutation.


Who Should Be Tested for a BRCA1 or BRCA2 Gene Mutation?

If a patient’s personal or family history indicates that he/she may be at increased risk of HBOC, genetic testing provides the most accurate means of assessing cancer risk. Knowing the potential risk can help you make better, more informed decisions about your patient’s health, before the onset of cancer or before a second cancer has developed.

Genetic testing for hereditary breast and ovarian cancer should be considered if:*

The Patient

  • Has had breast cancer at age 50 or younger
  • Has had ovarian cancer at any age
  • Has had triple negative breast cancer at any age
  • Is male and has had breast cancer at any age
  • Is of Ashkenazi Jewish descent and has a personal or family history of breast, ovarian or pancreatic cancer

The Patient’s Family

  • Has had two breast cancers in the same person or on the same side of the family
  • Has had someone diagnosed with triple negative breast cancer at any age
  • Has had pancreatic cancer and an HBOC-associated** cancer in the same person or on the same side of the family
  • Has three or more family members with breast cancer on the same side of the family
  • Has had a previously identified BRCA1 or BRCA2 mutation in the family


You can use the Myriad Hereditary Cancer Quiz as a tool to help you identify patients who may benefit from hereditary cancer testing.

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Using the Results of Hereditary Cancer Testing to Reduce Breast Cancer Risk

If hereditary cancer genetic testing confirms the presence of a BRCA1 or BRCA2 mutation or another mutation associated with breast cancer risk, the following medical management options may help to reduce your patient’s breast cancer risk and may either prevent or delay the onset of cancer or detect cancer at an earlier, more treatable stage, when outcomes are better.*


The Myriad myRisk APP provides up to date guidelines for medical management.

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References:

  1. Hughes K, et al. Rate of Abnormal is defined by cancer family history meeting red flags. The Breast Journal. (2003) 9(1):19-25.
  2. Claus EB, et al. The genetic attributable risk of breast and ovarian cancer. Cancer 1996;77:2318-2324.
  3. Pal T, et al. BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases. Cancer 2005;104(12):2807-2816.
  4. Risch H, et al. Prevalence and penetrance of germline BRCA1 and BRCA2 mutations in a population series of 649 women with ovarian cancer. Am J Hum Genet 2001: 68:700-710.

Lynch syndrome is the most common cause of hereditary colon cancer.

Myriad myRisk® Hereditary Cancer uses next-generation sequencing technology to identify patients who may be at risk so that they can take steps to lower their risk of cancer.

About three to five percent of colorectal cancers are believed to be caused by mutations in the MLH1, MSH2, MSH6, PMS2 or EPCAM genes.1 When a patient carries a mutation in any of these genes, he/she has a condition called Lynch syndrome, also known as Hereditary Non-polyposis Colorectal Cancer (HNPCC) syndrome.

People with Lynch syndrome are also at higher risk of developing several other types of cancer, including:

  • Endometrial cancer
  • Ovarian cancer
  • Gastric cancer
  • In addition, rarely, urinary tract, renal/pelvic, biliary tract, small bowel, pancreatic, and brain cancers


Some patients with Lynch syndrome may also develop sebaceous adenomas, noncancerous tumors of the sebaceous glands.
Myriad offers genetic testing to determine whether your patient is a carrier of any of the genetic mutations associated with Lynch syndrome.


Who Should Be Tested for Lynch Syndrome?

If a patient’s personal or family history indicates that he/she may be at an increased risk for Lynch syndrome, genetic test results provide the most accurate way to assess that patient’s cancer risk. Knowing the risk can help you and your patient make better and more informed decisions before the onset of cancer or before a second cancer has had a chance to develop.

Genetic testing for hereditary colon cancer should be considered if:*

The Patient

  • Has had colorectal or endometrial cancer before age 50
  • Has had colorectal cancer with MSI-high histology before age 60
    • Mucinous
    • Signet ring
    • Tumor infiltrating lymphocytes
    • Crohn’s-like lymphocytic reaction histology
    • Medullary growth pattern
  • Has had an abnormal MSI/IHC tumor test result (colorectal/endometrial)
  • Has had two or more Lynch syndrome cancers** at any age
  • Has had a Lynch syndrome cancer and has one or more relatives with a Lynch syndrome cancer**
  • Has a previously identified Lynch syndrome mutation in the family
  • Has a ≥5% risk of Lynch syndrome on one of the following mutation predication models: mmrpro, pREMM or MMR predict

The Patient’s Family

  • Has had two or more relatives with a Lynch syndrome cancer,** one before the age of 50
  • Has had three or more relatives with a Lynch syndrome cancer** at any age
  • Has a previously identified Lynch syndrome mutation in the family

Using Hereditary Cancer Testing to Reduce Colon Cancer Risk and Improve Patient Care

If hereditary cancer testing confirms the presence of a MLH1, MSH2, MSH6 or PMS2 mutation, the following medical management options may help reduce colon cancer risk and may either delay the onset of cancer or detect it at an earlier, more treatable stage:

About Polyposis Syndrome

Approximately two percent of all colon cancer is thought to be caused by one of three adenomatous polyposis conditions:2,3

  • Familial adenomatous polyposis
  • Attenuated familial adenomatous polyposis
  • MYH-associated polyposis

Classic familial adenomatous polyposis (FAP) and attenuated familial adenomatous polyposis (AFAP) are due to mutations in the adenomatous polyposis coli (APC) gene. Approximately 20 percent of APC-associated polyposis syndromes are caused by de novo mutations, in which an APC mutation is present in an individual, even though it is absent in both parents.4

MYH-associated polyposis (MAP) is caused by mutations in the mutY homolog (MYH) gene. This gene is an important part of the base excision repair (BER) pathway, which allows for repair of DNA mutations caused by oxidative damage to cells. Individuals with MAP have biallelic MYH mutations, or mutations in both of the MYH genes inherited from each parent. They often have no family history of colon cancer or polyps in their parents (although siblings may be affected).5

Since some polyposis syndromes like AFAP or MAP may not present with a significant personal/family history of colon cancer or colon polyps, genetic testing may be a useful tool to identify at risk individuals.4,5 Myriad offers genetic testing to determine whether your patient is a carrier of any of the genetic mutations associated with Lynch syndrome.

Who Should Be Tested for a Polyposis Syndrome

Identifying people who are at risk for adenomatous polyposis syndromes and monitoring them is perhaps the most critical step in changing hereditary cancer outcomes.

Genetic testing for a polyposis syndrome should be considered for:*

  • Individuals with multiple colorectal adenomas (usually 10 or more cumulative adenomas)
  • Personal history of a desmoid tumor, hepatoblastoma, cribriform-morular variant of papillary thyroid cancer
  • Relatives of APC or MYH mutation carriers

You can use the Myriad Hereditary Cancer Quiz as a tool to help you identify patients who may benefit from hereditary cancer testing.


Using the Results of Hereditary Cancer In Polyposis Syndromes

If hereditary cancer testing confirms the presence of an APC or MYH mutation, the following medical management options may help reduce cancer risk and may either delay the onset of cancer or detect it at an earlier, more treatable stage:6

  • Counseling for mutation carriers and their family members on the underlying cause of the cancer or adenomas.
  • Increased surveillance and other interventions specifically for individuals with the APC or MYH gene mutations.
  • Improved patient compliance through the use of tailored screening recommendations and preventive measures.
  • Significantly improved outcomes and reduced medical costs through early diagnosis and treatment of cancer.

You can use the Myriad Hereditary Cancer Quiz as a tool to help you identify patients who may benefit from hereditary cancer testing.

Myriad Genetics Logo

Get Started


The Myriad myRisk APP provides up to date guidelines for medical management.

myRisk App

Learn More

*Assessment criteria are based on individual medical society guidelines.

**Lynch-associated cancers include colon, endometrial, gastric, ovarian, urinary tract, renal/pelvic, biliary tract, small bowel, pancreatic, brain and sebaceous adenomas.

†Any discussion of medical management options is for general informational purposes only and does not constitute a recommendation. While genetic testing and medical society guidelines provide important and useful information, all medical management decisions should be made based on consultation between each patient and his or her healthcare professional.

References:

  1. Claus EB, et al. The genetic attributable risk of breast and ovarian cancer. Cancer 1996;77:2318-2324.
  2. Giardiello FM, et al. Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal

  3. Cancer. Am J Gastroenterol. 2014 109:1159-79. PMID:25070057.
  4. Burt R, Neklason DW. Genetic testing for inherited colon cancer. Gastroenterology 2005 May;128(6):1696-716.
  5. Halford SE, et al. Germline mutations but not somatic changes at the MYH locus contribute to the pathogenesis of unselected colorectal cancers. Am J Pathol 2003;162(5):1545-8.
  6. Jasperson KW, Burt RW. APC- Associated Polyposis Conditions. 2014 Mar 27. In: Pagon RA, et al., editors. GeneReviews® [Internet]. Available from http://www.ncbi.nlm.nih.gov/books/NBK1345/ PMID: 20301519
  7. Brand R, et al. MUTYH-Associated Polyposis. 2012 Oct 04. In: Pagon RA, et al., editors. GeneReviews® [Internet]. Available from http://www.ncbi.nlm.nih.gov/books/NBK107219/ PMID: 23035301
  8. Provenzale D, et al. NCCN Clinical Practice Guidelines in Oncology® Genetic/Familial High-Risk Assessment: Colorectal. V 1.2015. May 4th. Available at http://www.nccn.org

Know the red flags associated with hereditary cancer:

Red Flags for Hereditary Cancer
An individual with a personal or family history of any ONE of the following:

MULTIPLE CANCERS

A combination of cancers on the same side of the family

  • 2 or more: breast / ovarian / prostate / pancreatic cancer
  • 2 or more: colorectal / endometrial / ovarian / gastric / pancreatic / other cancers (i.e. ureter/renal pelvis, biliary tract, small bowel, brain, sebaceous adenomas)
  • 2 or more: melanoma / pancreatic

YOUNG CANCERS

Any 1 of the following cancers at age 50 or younger

  • Breast cancer
  • Colorectal cancer
  • Endometrial cancer

RARE CANCERS

Any 1 of these rare presentations at any age

  • Ovarian cancer
  • Breast: male breast cancer or triple negative breast cancer
  • Colorectal cancer with abnormal MSI/IHC, MSI associated histology††
  • Endometrial cancer with abnormal MSI/IHC
  • 10 or more gastrointestinal polyps*
Certain ancestries may have greater risk for hereditary cancer syndromes (e.g., Ashkenazi Jewish ancestry)


Assessment criteria based on medical society guidelines. For these individual medical society guidelines, go to www.MyriadPro.com/guidelines.
Family members include first-, second-, and third-degree blood relatives on both your mother and father’s sides.

*Adenomatous type.
††Presence of tumor infiltrating lymphocytes, Crohn’s-like lymphocytic reaction, mucinous/signet-ring differentiation, or medullary growth pattern.

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