Most Important Cancers to Ask About in Family History for Male Screening
For male patients, prostate cancer, colorectal cancer, and cancers associated with BRCA1/2 mutations are the most important cancers to inquire about in family history as they directly impact screening recommendations and can significantly reduce morbidity and mortality through early detection.
Prostate Cancer Family History
Prostate cancer shows strong familial aggregation and is a critical component of family history assessment for male patients:
- Men with a first-degree relative (father, brother, son) with prostate cancer have approximately a 2-fold increased risk of developing prostate cancer 1
- Risk increases with the number of affected relatives:
- Two first-degree relatives: 5-fold increased risk
- Three first-degree relatives: 11-fold increased risk 1
- Early-onset prostate cancer in relatives (diagnosed before age 60) is particularly significant 2
Screening Implications:
- While NCCN guidelines don't provide separate screening recommendations based solely on family history, they do recognize family history as an important risk factor that may require higher vigilance 2
- Family history should be used to help determine when to begin the early detection process within the NCCN recommended ages of 45-75 years 2
- Baseline PSA value is considered a stronger predictive factor than family history alone 2
Colorectal Cancer Family History
Colorectal cancer family history significantly impacts screening recommendations:
- According to American Gastroenterological Association guidelines, patients with a sibling, parent, or child who has had colorectal cancer or an adenomatous polyp should begin screening at age 40 instead of age 50 2
- Special efforts should be made to ensure screening if colorectal cancer was diagnosed in a close relative before age 55 or if an adenomatous polyp was diagnosed before age 60 2
- Men with a family history of colorectal cancer are twice as likely to utilize colorectal cancer screening than those without 3
Specific Hereditary Syndromes:
- Familial adenomatous polyposis: Genetic counseling and testing recommended; annual flexible sigmoidoscopy starting at puberty if gene carrier 2
- Hereditary nonpolyposis colorectal cancer (Lynch syndrome): Examination of entire colon every 1-2 years starting between ages 20-30 and yearly after age 40 2
- Lynch syndrome also increases risk for prostate cancer 2-5 fold 2
BRCA1/2 Mutations
BRCA mutations significantly impact prostate cancer risk and screening:
- BRCA2 mutations increase prostate cancer risk 2-6 fold 2
- BRCA1 mutations may increase risk, though the association is less consistent 2
- Prostate cancer in men with BRCA mutations tends to be more aggressive with reduced survival times 2
Screening Implications:
- NCCN Guidelines for Genetic/Familial High-Risk Assessment recommend that men with BRCA2 mutations begin prostate cancer screening at age 40 2
- Men with BRCA1 mutations should consider beginning screening at age 40 2
- Family history suggestive of BRCA mutations includes:
- Multiple relatives with breast cancer
- Relatives with ovarian cancer
- Relatives with pancreatic cancer 2
Other Important Family History Considerations
- Melanoma: Shows familial clustering and may warrant earlier/more frequent skin examinations 4
- Multiple cancers across generations: May suggest hereditary cancer syndromes requiring genetic counseling 2
- Second primary cancers: Family history doubles the risk of developing second primary cancers (particularly colorectal and lung) in men with prostate cancer 5
Clinical Approach to Family History Assessment
When taking a family history for cancer screening purposes in male patients:
Focus on first-degree relatives with cancer, particularly:
- Prostate cancer (especially if diagnosed <60 years)
- Colorectal cancer (especially if diagnosed <55 years)
- Breast and ovarian cancer (suggesting possible BRCA mutations)
- Pancreatic cancer (suggesting possible BRCA2 mutation)
- Multiple family members with cancer across generations
Consider genetic testing referral for:
- Strong family history of prostate cancer (multiple affected relatives, early onset)
- Known or suspected BRCA1/2 mutations in family
- Family patterns suggestive of Lynch syndrome
- Multiple relatives with breast, pancreatic, or prostate cancer (Gleason ≥7) 2
Document age of cancer diagnosis in relatives, as early-onset cancers often carry stronger genetic components and may warrant earlier screening
By focusing on these key cancers in family history assessment, clinicians can identify men who would benefit from modified screening approaches to reduce cancer morbidity and mortality.