Due to your family history you might be told that your family probably carries a genetic mutation, which makes it more likely that you or other relatives might get cancer. You might fall into any of the categories below.

• You might have had a gene test which found a mutation (positive result).
• You might have decided not to get yourself tested, but you have a strong family history which suggests a genetic cause for the cancers in your family.
• You might not have been able to have a genetic test because you don't have a living relative with that cancer who could be tested.
• Genetic testing is not available for the type of cancer running in your family (for example, pancreatic cancer).
• You had a genetic test, and no mutation was found. But because of your family history you have still been advised that your family is considered at high risk of developing a certain cancer.

Only if a mutation has been found through genetic testing can other family members be offered predictive testing to identify who is at increased risk and who is at the same risk as the general population

Either way, you may have to come to terms with the fact that you now know that your family has a higher-than-average cancer risk.

Some people say that being told about their high risk felt like finding out that they had cancer already. The only question in their mind is 'When will it happen to me?' Others say they feel as if history is repeating itself, with people in every new generation getting cancer, and bringing suffering and bereavement to the whole family. Other people say that after the first shock they felt relieved that they found out about their risk. They say that the facts are less scary than the fear they had before. They feel better when they know everything that is to be known, even if it is limited knowledge.

The relationships in your family can feel complicated or tense when you are coping with the risk of inherited cancer. If genetic tests identified some family members who are at an increased risk and some who aren't, you might all feel guilty or ashamed for different reasons. It is important to acknowledge that hereditary cancer can be a difficult issue to come to terms with.

Whether you feel like talking about this with your relatives or not, it might be helpful to get support from people outside your family, like your genetic counsellor, or a friend. You can also speak to a nurse on our helpline.

The Cancer Counselling Trust also offers support to people who are struggling with the effects of cancer.

Some people say that their relationships and family ties became stronger after they discovered the problems the family is facing and began working through them together. You might feel that you can rely on your family for support and help more than before you found out.

Screening becomes very important for some people who know that they are at increased risk. Bowel screening can pick up pre-cancerous cell changes, but other types of cancer screening only pick up cancers at an earlier stage than they might otherwise have been detected. Cancer screening often does not in itself prevent cancer. But it is important to remember that cancers which are detected earlier can be treated more effectively.

Many people say that having gone through genetic counselling and testing, and having regular screening, means that they are doing everything they can to increase their and their children's chances of good health. For that reason some people also start keeping a simple record of their family's health and major illnesses. They want to have the information available for their children or other relatives if they ever need it.

Living with the threat of cancer in your family can be very difficult. Other people live with these uncertainties, too. As in the case of any serious illness, many people who are affected insist that they still want to have a normal life.

Some people with a high cancer risk decide to have risk-reducing surgery. This means removing the organs which are at risk of getting cancer (the breasts, the ovaries, the bowel or the womb). The operation will only be offered to people with a high risk, such as people who have the genetic mutation for familial adenomatous polyposis (FAP)  Surgery greatly reduces, but does not entirely get rid of, cancer risk. No one can tell you whether this is the right or wrong thing for you to do. It is an entirely personal choice and may depend on:

• your age
• whether you still want to have children (in the case of removal of the ovaries)
• whether you know for sure that you have a genetic mutation
• how you feel.

If you are considering this option at all, you have the right to take your time over the decision and to get help and advice from doctors and counsellors. It is helpful to discuss all the advantages and disadvantages with your doctor, family and other people you trust and then spend some time thinking about this. We have information about risk-reducing breast surgery.

If you know that you have an increased risk of getting cancer, you might be offered the opportunity to join research trials, looking into genetic causes for cancer or different ways of preventing cancer. For example, different drugs are being used to try to reduce inherited breast cancer risk. These are known as chemoprevention trials. Some people say that joining a research trial makes them feel that they are 'doing their bit' to increase knowledge in the area of cancer genetics. But whether you want to take part in research is entirely your decision.