The NCCN has updated its guidelines for hereditary breast, ovarian, and pancreatic cancers as well as hereditary colon, endometrial, and gastric cancers. These changes include important updates to genetic testing criteria, management recommendations, and screening guidance. Complete guidelines can be found at www.nccn.org.
NCCN Hereditary Breast, Ovarian, Pancreatic, and Prostate Cancer (v2.2026 Oct 10, 2025)
- An expanded list of pathologies are now included for ovarian cancer testing criteria
- Testing now indicated for non-epithelial ovarian cancer (sex-cord tumors with annular tubules [SCTAT], small cell carcinoma of the ovary (hypercalcemic type) (SCCOHT) at any age
- Testing now indicated for serous tubal intraepithelial carcinoma (STIC) at any age
- An expanded list of pathologies are now included for pancreatic cancer testing criteria
- All individuals diagnosed with exocrine pancreatic cancer including acinar cell carcinoma.
- For prostate cancer, family history testing criteria widened to include second as well as first degree relatives
- Upgraded prostate cancer as having a strong association with BRCA1 and a very strong association with BRCA2.
- Prostate cancer screening recommendations clarified and expanded:
- BRCA2 carriers: Recommend annual prostate cancer screening with PSA
- BRCA1 carriers: Consider annual prostate cancer screening with PSAmpMRI may also be included in screening, with a baseline exam performed at age 50 (or 10 years younger than the youngest age of prostate cancer diagnosis in the family), preferably on clinical trial.
NCCN Hereditary Colon, Endometrial and Gastric Cancer (v1.2025 June 13, 2025)
- Criteria for Lynch syndrome testing expanded to include individuals with family history of: one or more first or second -degree relatives with CRC or EC and a synchronous or metachronous LS-related cancer regardless of age.
- Regardless of LS tumor test results, genetic evaluation is recommended if the patient is under age 50 at time of diagnosis. Additionally, an individual without a known MMR deficiency may still warrant additional genetic evaluation based on personal and family history.
- Sarcoma has been added as a cancer risk for MSH2/EPCAM, though it is noted that there is no clear evidence to support surveillance for sarcoma in Lynch syndrome.
- PMS2-related cancer risks for ovarian, renal pelvis and ureter, bladder, gastric, small bowel, pancreas, biliary tract, prostate, breast (female), brain and skin removed and replaced with statement: “While other LS-associated cancers have been observed in individuals with PMS2 LS, it is unclear whether PMS2 LS carriers have increased risk for these cancers compared to the general population. Accordingly, data are insufficient to provide cancer risk estimates or cancer surveillance/risk reduction recommendations beyond those for CRV and EC. Surveillance regimens for cancers other than CRCs or ECs among PMS2 LS carriers should be individualized based on personal and family cancer history, and clinical judgement.”
Complete guidelines can be found at www.nccn.org.