© Darina Belonogova
October 22, 2026
Dr. med. Laura von der Heyden
When cancer runs in the family, questions about one's own risk often follow. In the first installment of her column, geneticist Dr. Laura von der Heyden explains how inherited genetic variants influence the risk of breast, colorectal, and prostate cancer — and how this knowledge can change preventive care.
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Dr. med. Laura von der Heyden
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Breast-, colorectal, and prostate cancer are among the most common cancers. Most cases develop through changes acquired over the course of a lifetime, but in some cases a hereditary predisposition plays a role. For breast cancer, approximately five to ten percent of cases are linked to disease-causing hereditary changes.
A genetic test can identify such a predisposition before any disease occurs. The result can help open up early, informed conversations about prevention options and next steps — on one's own terms.
Approximately one in eight women will developbreast cancerduring their lifetime. In carriers of a disease-causing BRCA1 or BRCA2 variant, that risk is significantly higher. Estimates vary depending on the gene and the population studied; for BRCA1, they reach up to 80 percent by age 70. The risk of ovarian cancer is also elevated, particularly for BRCA1.
Beyond BRCA1 and BRCA2, other genes are associated with increased risk, including PALB2, CHEK2, and ATM. The degree of risk elevation and the appropriate preventive measures differ from gene to gene. Modern panel diagnostics can examine all of these genes in a single step.
An abnormal finding can open the door to concrete options. Women with a corresponding predisposition can access a risk-adapted early detection program at specialized centers — one that starts earlier and may include different examinations than standard mammography screening. Risk-reducing breast surgery can significantly lower the likelihood of developing breast cancer, though it does not eliminate the risk entirely. Genetics can also be relevant during treatment: PARP inhibitors may be an option for certain tumor types at defined stages of disease.
The right path depends on age, life plans, and personal values. This is not a decision that anyone has to make alone or under pressure.
"A risk gene is not a diagnosis. It is a head start — if you use it."
Around three to five percent of all colorectal cancers are hereditary.
The most common hereditary form is Lynch syndrome, followed less frequently by familial adenomatous polyposis (FAP). Signs of a possible hereditary cause include multiple cases of the disease within one family line, a young age at diagnosis, or a clustering of specific tumor types — such as colorectal and endometrial cancer in Lynch syndrome.
The good news is that colorectal cancer typically develops over many years from precancerous lesions. For certain hereditary tumor syndromes, colonoscopy therefore begins at a young age and is performed at close intervals. This makes it possible to detect changes early — and often remove them while they are still at the precancerous stage.
What many people don't realize is that BRCA variants affect men too. BRCA2 in particular is associated with an elevated risk ofprostate canceras well as a younger age at diagnosis and a higher proportion of clinically significant tumors.
Other genes, including HOXB13 and ATM, can also contribute to hereditary prostate cancer. For men carrying a BRCA2 variant, PSA-based early detection from age 40 may be worth considering. The benefits and potential drawbacks should be discussed individually with a physician.
There is another important consideration: men pass on a BRCA variant to their children with a probability of 50 percent — including their daughters. Hereditary cancer is therefore never solely a women's issue; it is always a matter that concerns the entire family.
It is worth paying attention if multiple family members have been diagnosed with cancer, if diagnoses occurred at a young age, or if ovarian cancer or breast cancer in a male family member is part of the picture. But even without a striking family history, testing may be worthwhile — small families or gaps in medical information can easily obscure underlying risks. The starting point is always a thorough consultation.
When cancer runs in the family, questions about one's own risk often follow. In the first installment of her column, geneticist Dr. Laura von der Heyden explains how inherited genetic variants influence the risk of breast, colorectal, and prostate cancer — and how this knowledge can change preventive care.
Dr. med. Laura von der Heyden
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