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©2013 UpToDate ® Print Email Algorithm for genetic counseling referral from the Clinical Cancer Genetics Program at Ohio State University Non-Jewish families High risk* breast-ovarian; any of the following: One case of breast cancer ≤40-years-old in a first or second-degree relative One first or second-degree relative with both breast and ovarian cancer at any age Two cases of breast cancer in first or second-degree relatives if one is diagnosed at ≤50 years of age or is bilateral One first or second-degree relative with breast cancer diagnosed at ≤50-years-old or bilateral and one first or second-degree relative with ovarian cancer Three cases of breast and ovarian cancer (at least one case of ovarian cancer) in first or second-degree relatives Two cases of ovarian cancer in first or second-degree relatives One case of male breast cancer in a first or second-degree relative if another first or second degree relative has (male or female) breast or ovarian cancer Moderate risk* breast; any of the following: Two first-degree relatives if both diagnosed between 51 and 60 years of age One first degree and one second-degree relative (mother or sister and maternal aunt or maternal grandmother), if the sum of their ages is ≤118-years-old Moderate risk ovarian: One first-degree relative with ovarian cancer Jewish families High risk* breast-ovarian; any of the following: One case of breast cancer ≤50-years-old in a first or second-degree relative One case of ovarian cancer at any age in a first or second-degree relative A first or second degree relative with breast cancer at any age if another first or second degree relative has breast and/or ovarian cancer at any age One case of male breast cancer in a first or second-degree relative * High risk: Family histories suggestive of a hereditary cancer susceptibility syndrome where the individual would benefit from referral to a cancer genetics professional and increased cancer surveillance; Moderate risk: Family histories not diagnostic of a hereditary cancer susceptibility syndrome but conferring an increased risk for cancer, requiring increased cancer surveillance. Hampel H, et al. J Med Genet 2004; 41:81.