Family history of cancer: when to refer to a cancer genetics clinic (breast, ovary, colon, endometrium, prostate, pancreas, melanoma)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Breast, ovary: Eisinger score
- No laboratory test to prescribe: refer to an oncogenetics consultation (INCa directory), with the family tree (both parental branches, age at diagnosis of each cancer) and, if possible, the pathology reports.
- Calculate the Eisinger score in each parental branch: refer if ≥ 3.
Do not order
- CA 125 or CA 15-3 to "screen" in a woman with a family history: coverage limited to therapeutic monitoring [5]
- "Direct-to-consumer" genetic test (online sale) or test prescribed outside a genetics consultation: requesting examination of one's genetic characteristics outside the legal framework is punishable by a fine of 3 750 € [11]; prescription is a matter for a multidisciplinary team [3]
Colon, endometrium (Lynch syndrome, polyposis)
- No laboratory test to prescribe: refer to an oncogenetics consultation (INCa directory), with the family tree (both parental branches, age at diagnosis of each cancer) and, if possible, the pathology reports.
- Enclose the MMR status (immunohistochemistry or microsatellite instability) of the affected parent's tumour if known.
Do not order
- CEA to screen for familial colorectal cancer: coverage limited to therapeutic monitoring [5]
- "Direct-to-consumer" genetic test (online sale) or test prescribed outside a genetics consultation: requesting examination of one's genetic characteristics outside the legal framework is punishable by a fine of 3 750 € [11]; prescription is a matter for a multidisciplinary team [3]
Prostate, pancreas, melanoma, other
- No laboratory test to prescribe: refer to an oncogenetics consultation (INCa directory), with the family tree (both parental branches, age at diagnosis of each cancer) and, if possible, the pathology reports.
Do not order
- CA 19-9 to screen for familial pancreatic cancer: coverage limited to therapeutic monitoring [5]
- "Direct-to-consumer" genetic test (online sale) or test prescribed outside a genetics consultation: requesting examination of one's genetic characteristics outside the legal framework is punishable by a fine of 3 750 € [11]; prescription is a matter for a multidisciplinary team [3]
Familial variant already identified: relative
- Refer the adult relative to an oncogenetics consultation for targeted testing (with the index case's report if they have it).
Do not order
Sources (22)
- Sessa C, Balmaña J, Bober SL, et al. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline. Ann Oncol. 2023;34(1):33-47.
- Institut national du cancer. Les niveaux de risque de cancer colorectal (espace professionnels de santé), mis à jour le 28 mai 2026, consulté le 13 octobre 2026.
- Code de la santé publique, articles R. 1131-5 (version issue du décret n° 2023-1426 du 30 décembre 2023) et L. 1131-1 (version issue de la loi n° 2021-1017 du 2 août 2021).
- Institut national du cancer. Le dispositif national d'oncogénétique (espace professionnels de santé), mis à jour le 4 juin 2025, consulté le 13 octobre 2026 (avec l'annuaire 2025 des consultations).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 7321 (CA 15-3), 7323 (CA 19-9), 7325 (CA 125), 7327 (ACE) ; absence d'acte d'analyse des gènes BRCA ou MMR.
- Haute Autorité de santé. Dépistage du cancer du sein en France : identification des femmes à haut risque et modalités de dépistage. Volet 2, mars 2014 (tableau 1 : score d'indication de la consultation d'oncogénétique, d'après Eisinger et al., Bull Cancer 2004;91(4):219-37).
- Institut national du cancer. Dépistage du cancer du sein : orienter vos patientes (espace professionnels de santé), mis à jour le 5 février 2024, consulté le 13 octobre 2026.
- National Institute for Health and Care Excellence. Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (CG164). Publiée le 25 juin 2013, mise à jour le 14 novembre 2023.
- US Preventive Services Task Force. BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing. Final Recommendation Statement, 20 août 2019 (mise à jour en cours).
- Royal Australian College of General Practitioners. Genomics in general practice, 2e édition : Familial breast and ovarian cancer.
- Code pénal, article 226-28-1 (version issue de la loi n° 2011-814 du 7 juillet 2011).
- Haute Autorité de santé. Cancer colorectal : modalités de dépistage et de prévention chez les sujets à risque élevé et très élevé. Fiche mémo, mai 2017.
- Seppälä TT, Latchford A, Negoi I, et al. European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender. Br J Surg. 2021;108(5):484-498.
- National Institute for Health and Care Excellence. Molecular testing strategies for Lynch syndrome in people with colorectal cancer (HealthTech guidance HTG430, anciennement DG27). Publiée le 22 février 2017.
- Royal Australian College of General Practitioners. Genomics in general practice, 2e édition : Familial colorectal cancer.
- Association française d'urologie, Comité de cancérologie (CCAFU). Cancer de la prostate : mémo de poche des recommandations (« PM AFU – Cancer de la prostate »), chapitre 1 « Génétique », tableaux 1 et 2. Mis en ligne en novembre 2021.
- European Association of Urology (EAU), EANM, ESTRO, ESUR, ISUP, SIOG. Guidelines on Prostate Cancer. Édition présentée au congrès annuel de l'EAU, Londres, 2026 ; chapitre 5, section 5.2.8 « Germline testing ».
- Goggins M, Overbeek KA, Brand R, et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut. 2020;69(1):7-17.
- Avril MF, Bahadoran P, Cabaret O, et al. Recommandations pour l'analyse génétique et la prise en charge des personnes à risque génétique de mélanome cutané. Ann Dermatol Venereol. 2015;142(1):26-36.
- Daly MB, Pal T, Maxwell KN, et al. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2024. J Natl Compr Canc Netw. 2023;21(10):1000-1010.
- Royal Australian College of General Practitioners. Genomics in general practice, 2e édition : Familial prostate cancer.
- Royal Australian College of General Practitioners. Genomics in general practice, 2e édition : Familial melanoma.