Breast and Ovarian Cancers and Family History Risk Categories

Key points

  • Risk for breast, ovarian, and certain other cancers based on family health history can be classified as average, moderate, or strong.
  • People with a family history of these cancers can use the examples included here to better understand their family health history risk and next steps they can take.
Image of a breast cancer ribbon and a multigenerational family.

Overview

This web page provides examples of average, moderate, and strong family health histories of breast and ovarian cancers. This may help you understand if you have an increased risk for these cancers based on your family health history. This web page does not include all possible family health histories of breast and ovarian cancers.

If you have concerns about your family health history of breast or ovarian cancers, please talk to your healthcare provider. Your doctor may assess your risk based on your personal and family health history, using one of the following:

Results may vary, depending on the tool used, and may differ from the risk categories below, which are based largely on the guidelines from the National Comprehensive Cancer Network.1

Family history risk categories

Average

Risk based on family history is not increased and is similar to the general population risk. Genetic counseling and testing for hereditary breast and ovarian cancer is not typically recommended for families with average risk.

Family health history includes one or more of the following:

  • No first–degreeA or second-degreeB relatives with breast or ovarian cancer
  • One second-degree female relative with breast cancer (in one breast only) diagnosed after age 50

Example: Grandmother with breast cancer diagnosed at age 75

Steps you can take:

  • Follow current recommendations and start getting mammograms at age 40.
  • Keep a healthy weight, exercise regularly, and make other choices to lower your risk.
  • Discuss any concerns with your healthcare provider.

Moderate

Risk based on family history is somewhat higher than the general population risk, but most women from moderate risk families will not develop breast or ovarian cancer. Genetic counseling and testing for hereditary breast and ovarian cancer is unlikely to be recommended for this type of family, unless the family has Ashkenazi or Eastern European Jewish ancestry.

Family health history includes one or more of the following:

  • One or two first–degreeA or two second-degreeB female relatives with breast cancer (in one breast only), with both relatives diagnosed after age 50
  • One or two second-degree relatives with high grade prostate cancer or pancreatic cancer

Example: Mother with breast cancer diagnosed at age 68 and maternal aunt (mother's sister) with breast cancer diagnosed at 62

Steps you can take:

Taking action may be of greater benefit for women with a moderate (compared with average) risk family history.

  • Follow current recommendations and start getting mammograms at age 40.
  • Keep a healthy weight, exercise regularly and make other choices to lower your risk.
  • Discuss any concerns with your healthcare provider.

Strong

Not all women in these families will develop breast or ovarian cancer, but risk is much higher than that of the general population. Genetic counseling and testing for hereditary breast and ovarian cancer is often recommended for this type of family.

Family history includes one (or more) first–degreeA or second-degreeB relative(s) with one or more of the following:

  • Breast cancer diagnosed at age 50 or younger in women
  • Triple negativeC breast cancer in women
  • Primary cancer of both breasts
  • Both breast and ovarian cancer in the same relative
  • Male breast cancer
  • Ovarian cancer
  • Pancreatic cancer in a first-degree relative
  • High grade prostate cancer in a first-degree relative
  • Two or more first– or second-degree relatives from the same side of the family with at least one relative with breast cancer and one relative with pancreatic cancer or high-grade prostate cancer at any age.

Examples

Sister with breast cancer diagnosed at age 40

Paternal aunt (father's sister) with breast cancer diagnosed at age 45 and paternal grandmother (father's mother) with breast cancer diagnosed at age 55

Mother with ovarian cancer

Uncle with pancreatic cancer at age 55 and paternal grandmother with breast cancer at age 60

Steps you can take:

  • Talk with your healthcare provider about cancer genetic counseling.

Ashkenazi or Eastern European Jewish ancestry and breast and ovarian cancers risk

If you are a woman of Ashkenazi or Eastern European Jewish ancestry and have a moderate family health history of breast and ovarian cancers, you should talk with your healthcare provider about genetic counseling and testing. Women of Ashkenazi or Eastern European Jewish ancestry are more likely to have BRCA1 and BRCA2 mutations, regardless of their family health history. This means that women of Ashkenazi or Eastern European Jewish ancestry who have a family health history of breast or ovarian cancer are at higher risk than women of other ancestries with similar family health histories. A family health history that would be considered moderate risk for most women might be considered strong risk for women of Ashkenazi or Eastern European Jewish ancestry.

Keep Reading: Genetic Counseling for Hereditary Breast and Ovarian Cancer
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Content Source:
National Center on Birth Defects and Developmental Disabilities (NCBDDD)
  1. First-degree relatives are parents, brothers, sisters, and children.
  2. Second-degree relatives are half-sisters, half-brothers, aunts, uncles, nieces, nephews, grandparents, and grandchildren.
  3. Triple negative cancers are a type of breast cancer that lack estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2.
  1. National Comprehensive Cancer Network. NCCN Guidelines Version 3.2024 Genetics/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic.