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Hereditary Cancer Info > Risk Management > Risk Management Guidelines

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Risk Management Guidelines

Learn about the steps that people at high risk for cancer can take to manage their risk and protect their health.

NCCN Guidelines for men and women with Li-Fraumeni syndrome (TP53 Mutations)

Breast cancer screening for women

  • Learning to be aware of changes in breasts beginning at age 18
  • Clinical breast exam every 6-12 months beginning at age 20
  • Annual breast MRI with contrast or mammogram beginning at age 20 (MRI preferred) or at the age of earliest breast cancer diagnosis if there is a history of breast cancer before age 20 in family
  • Annual breast MRI and mammogram beginning at age 30
  • Consider 3D mammography
  • Screening after age 75 should be considered on an individual basis

Breast cancer risk reduction for women

  • Discussion of risk-reducing mastectomy

Additional cancer screening for men and women

  • Annual physical exam
  • Annual skin cancer screening starting at age 18
  • Annual whole body MRI
  • Annual brain scan (either as part of whole body MRI or separately)
  • Consider colonoscopy every 2-5 years beginning at age 25
  • Additional screening based on family cancer history
  • Alert pediatricians to the mutation in the family and the associated risk of childhood cancers
  • Provide education regarding signs and symptoms of cancer
  • Address psychosocial, social and quality of life aspects of the complext management of Li-Fraumeni Syndrome

Pancreatic cancer

Pancreatic cancer screening is done using two types of medical procedures: 

  • Magnetic resonance cholangiopancreatography (MRCP) is a special type of imaging MRI that is used to look at the pancreas, liver, gallbladder, bile duct and pancreatic duct. 
  • Endoscopic ultrasound (EUS) involves passing a tiny scope with an attached ultrasound probe down the esophagus to the stomach. This allows doctors to look closely at the pancreas.

Experts guidelines say:

  • People with a mutation in Li-Fraumeni and those with a family history of pancreatic cancer, are encouraged to discuss the pros and cons of annual screening with their health care provider. 
  • Experts do not currently recommend pancreatic cancer screening for people with a TP53 mutation who do not have a close family history of pancreatic cancer.
  • For those who decide to undergo pancreatic cancer screening, consider beginning at age 50 or 10 years earlier than the earliest pancreatic cancer diagnosis in the family.
  • Screening should begin with annual MRCP and/or EUS (both ideally performed at a center with expertise).

People with a TP53 mutation may also be eligible for pancreatic cancer screening clinical trials. Visit our research study page for links to clinical trials for early detection of pancreatic cancer.

Reproductive options

  • For patients of reproductive age, advise about options for prenatal diagnosis and assisted reproduction including pre-implantation genetic diagnosis. 

Risk to relatives

  • Advise about possible inherited cancer risk to relatives, options for risk assessment, and management. 
  • Recommend genetic counseling and consideration of genetic testing for at-risk relatives. 



Updated 02/03/2020

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