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PTEN (Cowden Syndrome): Risk Management

Learn about the screening and prevention guidelines for people with a mutation in their PTEN gene. Stay up to date by signing up for our community newsletter.
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Risk Management for People with Inherited Mutations

The National Comprehensive Cancer Network (NCCN) provides risk management guidelines for people with a  mutation. We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and can help you determine the best risk management plan. You can learn more about risk management options in our section on Screening and Risk Reduction by Cancer Type

  • breast cancer
  • endometrial cancer
  • thyroid, colorectal, kidney, skin and other cancers

People with a  mutation may also qualify for clinical trials looking for more effective screening or prevention for cancer.

In addition to the guidelines below, people with mutations should learn the symptoms of cancer and report any changes in their health to their doctor. 

Note that when we use "women" we are referring to people assigned female at birth.

Visit our Partners

PTEN Hamartoma Tumor Syndrome Foundation

This foundations offers support, research and resources for people with inherited PTEN mutations.

Breast cancer risk management for women and people assigned female at birth

Beginning Age

Recommendation

Additional Information

18

Learn to be aware of changes in your breasts.

25 or 5–10 years before the earliest known breast cancer in the family (whichever comes first).

Breast exam by doctor every 6-12 months.

30 or 10 years before the earliest known breast cancer in the family (whichever comes first)

Yearly breast MRI with and without contrast.

30 or 10 years before the earliest known breast cancer in the family (whichever comes first)

Yearly mammogram.

No set age

Discuss the benefits, risks and costs of double mastectomy with your doctor.

Risk-reducing mastectomy lowers breast cancer risk by 90%, but has not been shown to improve survival. Even after double mastectomy, some breast tissue, and therefore cancer risk remains.

75

Consider whether to continue, stop or change breast screening.

Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025


Risk management for endometrial cancer 

Beginning Age

Recommendation

Additional Information

No set age

Endometrial cancer can often be caught early based on symptom awareness followed by a biopsy. Learn to be aware of the symptoms of endometrial cancer and immediately report any symptoms to your doctor. Keep a diary of menstrual cycles in order to detect any changes in bleeding.

Symptoms of endometrial cancer include:

  • unusual vaginal bleeding
  • pelvic or abdominal pain
  • bloating or distended belly
  • difficulty eating
  • increased urination or pressure to urinate

35

Discuss the benefits, risks and costs of an endometrial biospsy every 1-2 years with your doctor.

More research is needed to show a benefit of endometrial cancer screening in people with a PTEN mutation. However, endometrial biopsy is an accurate test for finding cancer.

After menopause

Discuss the benefits, risks and costs of regular endometrial cancer screening through transvaginal ultrasound.

Endometrial cancer screening does not have proven benefit in individuals with Lynch syndrome. Despite this, some people prefer to undergo regular screening through transvaginal ultrasound.

After childbearing has been completed

Discuss the benefits, risks and costs of a risk-reducing hysterectomy (surgical removal of the uterus) and salpingectomy (surgical removal of the fallopian tubes).

  • For people who need colorectal surgery, consider coordinating hysterectomy at the same time.
  • Total hysterectomy lowers the risk, but it has not been shown to reduce death from endometrial cancer.

Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic; v1. 3 2024


Risk management for colorectal, thyroid, kidney and other cancers 

Beginning Age

Recommendation

7

Annual thyroid ultrasound

Children diagnosed with a PTEN mutation

Exam by a neurologist and brain MRI if there are symptoms

18 (or 5 years earlier than the earliest cancer diagnosis in the family)

Annual physical exam by doctor

No set age

Annual skin exam

35 (or earlier if symptoms or if a close relative had colorectal cancer before age 35)

Colonoscopy every 5 years

40

Discuss the benefits, risks and costs of kidney ultrasounds every 1-2 years

Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, vs. 1 2025


Last updated September 22, 2024