NCCN Updates Guidelines for Genetic Testing Related to Breast, Ovarian, and Pancreatic Cancer

By Eleanor Griffith, MS, CGC · Dec 2019

NCCN again updated guidelines related to genetic testing, this time adding Pancreatic Cancer to the title: "Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic." The title expansion may help with clarity, since pancreatic (and prostate) cancer were already part of these guidelines.

New: Pancreatic Cancer Screening Section

A new two-page pancreatic cancer screening section summarizes emerging data. NCCN reiterates that this screening should ideally occur in a research setting. For individuals with an associated hereditary cancer mutation and two or more relatives with pancreatic cancer, guidelines now suggest considering pancreatic cancer screening beginning at age 50 — or 10 years before the earliest diagnosis in the family.

Breast Cancer Criteria: A Nuance

In addition to the existing threshold of ≥5% prior probability of carrying a hereditary cancer mutation, the guidelines now also state that women with ≥2.5% probability "may be considered" for testing. However, NCCN also clarifies that there is a less than 2.5% probability that testing will have clinical utility for women diagnosed with breast cancer over age 65 with no close relatives with relevant cancers.

Ovarian Cancer: Still Universal

All women with ovarian cancer still meet criteria for hereditary cancer testing — as has been true for over a decade. Individuals with a first- or second-degree relative diagnosed with ovarian cancer also meet criteria. This is not new, but it remains under-recognized and under-implemented.