Risk management for people with inherited PTEN mutations
The National Comprehensive Cancer Network (NCCN) provides risk management guidelines for men and women with inherited PTEN mutations. We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and can help you determine the best risk management plan. You can learn more about risk management options in our section on Screening and Risk Reduction by Cancer Type.
Breast cancer risk management
Breast cancer screening
- Learning to be aware of changes in breasts beginning at age 18.
- Clinical breast exam every 6-12 months beginning at age 25 (or 10 years earlier than the youngest age of onset in the family).
- Annual mammography with consideration of tomosynthesis and breast MRI with contrast beginning at age 30-35 (or 5-10 years earlier than the youngest breast cancer in the family).
Risk-reducing mastectomy
- Women should have a discussion with their doctors about of the advantages and disadvantages of risk-reducing mastectomy.
- Research has shown that risk-reducing mastectomy can effectively lower the risk for breast cancer in high risk women by about 90%. Despite this, mastectomy has not been shown to improve overall survival for high risk women. Even after mastectomies, some breast tissue-and therefore some breast cancer risk remains.
Endometrial cancer risk management
- Women should be educated on the possible symptoms of ovarian or uterine cancer. They should immediately report any unusual vaginal bleeding, pelvic or abdominal pain, bloating, increased abdominal girth, difficulty eating, or increased urinary frequency or urgency to health care providers
- Women should keep a calendar of their menstrual cycle and note any irregular bleeding or any postmenopausal bleeding.
- Consider endometrial biopsy every 1 to 2 years beginning at age 35.
- Consider transvaginal ultrasound for postmenopausal women.
- Consider hysterectomy after childbearing is complete.
Other cancers
The National Comprehensive Cancer Network (NCCN) guidelines recommend:
- Annual comprehensive physical exam beginning at age 18 or 5 years earlier than the earliest cancer diagnosis in a family.
- Annual thyroid ultrasound beginning at age 7.
- Colonoscopy beginning at age 35 unless symptomatic or if a close blood relative had colon cancer before age 40. Continue screening every 5 years.
- Consider renal ultrasound beginning at age 40 then every 1-2 years.
- Annual skin exams.
- Consider psychomotor assessment in children at diagnosis and brain MRI if there are symptoms.
There has not been enough research to show a benefit from screening and prevention for other cancers in people who have a PTEN mutation. For this reason, experts recommend managing other cancer risks based on family history. Cancer screening and prevention research studies may be available for people with PTEN mutations.
If you are a person with an inherited PTEN mutation, you can find peer support through the following resources:
- Register for the FORCE Message Boards to connect with others who share your situation. Once you register, you can post on the Share Your Mutation board to connect with other people who carry a PTEN mutation.
- FORCE's Peer Navigation Program will match you with a volunteer who shares your mutation and situation and provide you with a free resource guide.
- Contact the FORCE impact leaders in your area to link to local support groups and other resources.
- Attend a virtual support meeting in your area.
- Read the stories from members of our community.
Support through other organizations:
- The PTEN Hamartoma Tumor Syndrome Foundation has resources for people affected by an inherited PTEN mutation.
Health plan coverage of screening and prevention varies, and deductibles, coinsurance and copays often apply. If you need preventive services and your insurance company denies your claim, your health care provider can help you write an appeal letter, or you can use one of our sample appeal letters. Visit our section on Insurance and Paying for Care: Screening and Prevention for more information.
The following screening and prevention studies may be open to people with a PTEN mutation.
- NCT04094675: Sirolimus for Cowden Syndrome With Colon Polyposis. This study is investigating a medication known as sirolimus and its effect on the number of colon polyps in patients with Cowden syndrome and polyposis over a 1 year period.