Genetic predisposition to cancer

Over the last 24 years there has been a burgeoning development of genetic risk assessment and ‘family history’ clinics to deal with the ever-increasing demand from individuals at increased risk of cancer by virtue of their family history. Risk of inherited cancer can be divided into known syndromes, such as familial polyposis, and increased risk of common cancers due to family history alone. Risk of cancer can be assessed in three categories: average, moderate and high. Individuals at high risk and those at risk of syndromes will generally be referred to a regional genetics centre. Moderate-risk individuals may benefit from early surveillance in secondary care particularly for breast and colorectal cancer. Average-risk individuals can be reassured in primary care. Newer surveillance techniques such as MRI screening are now being approved in high-risk categories. Genetic testing for a minority of high-risk individuals is now in routine practice and surgical management options have gained validity. Much research is still necessary to improve early detection and develop non-surgical means of prevention.