MLH3 Biallelic gene - Cancer risk, management, and testing for genetic mutations

Associated Syndrome Name: MLH3-associated polyposis syndrome

MLH3 Biallelic Summary Cancer Risk Table

Cancer Genetic Cancer Risk
ColorectalElevated Risk

MLH3 Biallelic gene Overview

MLH3-associated polyposis syndrome 1, 2
  • Individuals with mutations in both copies of the MLH3 gene (biallelic mutations) have MLH3-associated polyposis syndrome. This syndrome has been found in a small number of individuals with 20-100+ colorectal polyps and a history of early onset colorectal cancer. Although there are currently no precise estimates of the colorectal cancer risk associated with MLH3-associated polyposis syndrome, it is possible that this risk is significantly increased over that in the general population.
  • The small number of individuals in families with MLH3-associated polyposis syndrome have been diagnosed with other types of cancers including breast, endometrial, and brain cancer. However, more studies are needed to determine if these (or any other cancers) are conclusively associated with MLH3-associated polyposis syndrome.
  • Although there is an increased risk for colorectal cancer and polyposis in individuals with MLH3-associated polyposis syndrome, it may be possible to reduce this risk with appropriate medical management. Guidelines for the medical management of these individuals have been developed by the National Comprehensive Cancer Network (NCCN), which are listed below. These guidelines will evolve as we learn more, and it is recommended that patients with MLH3-associated polyposis syndrome be managed by a multidisciplinary team with expertise in medical genetics and the care of patients with hereditary cancer syndromes.

MLH3 Biallelic gene Cancer Risk Table

Cancer Type Age Range Cancer Risk Risk for General Population
ColorectalTo age 803Elevated risk2.8%

MLH3 Biallelic Cancer Risk Management Table

The overview of medical management options provided is a summary of professional society guidelines. The most recent version of each guideline should be consulted for more detailed and up-to-date information before developing a treatment plan for a particular patient.

This overview is provided for informational purposes only and does not constitute a recommendation. While the medical society guidelines summarized herein provide important and useful information, medical management decisions for any particular patient should be made in consultation between that patient and his or her healthcare provider and may differ from society guidelines based on a complete understanding of the patient’s personal medical history, surgeries and other treatments.

Cancer Type Procedure Age to Begin Frequency
(Unless otherwise indicated by findings)
ColorectalColonoscopy125 to 30 yearsEvery 2 to 3 years
Colorectal surgical evaluation and counseling.1Based on cancer diagnosis and/or polyp number, size and histologyNA

Benefits of Testing for MLH3 Biallelic Gene Mutations:

Testing for MLH3 Biallelic gene mutations with the MyRisk® Hereditary Cancer Test with RiskScore® provides critical insights to patients and providers about potential hereditary cancer risk. Identifying a MLH3 Biallelic gene mutation can help clarify whether a patient is at increased risk for certain cancers and guide proactive, personalized care planning. With definitive answers from the MyRisk Test, healthcare providers can better tailor screening, prevention, and management strategies, while patients gain clarity and confidence about their hereditary cancer risk. In addition, understanding a MLH3 Biallelic gene mutation allows family members to consider their own hereditary cancer risk, supporting informed decision-making and potentially life-saving early interventions. Learn more about the MyRisk® with RiskScore® Hereditary Cancer Test.

Information for Family Members

The following information for Family Members will appear as part of the MMT for a patient found to have a mutation in the MLH3 Biallelic gene.

This patient's relatives are at risk for carrying the same mutation(s) and associated cancer risks as this patient. Cancer risks for females and males who have this/these mutation(s) are provided below.

Family members should talk to a healthcare provider about genetic testing. Close relatives such as parents, children, brothers and sisters have the highest chance of having the same mutation(s) as this patient. Other more distant relatives such as cousins, aunts, uncles, and grandparents also have a chance of carrying the same mutation(s). Testing of at-risk relatives can identify those family members with the same mutation(s) who may benefit from surveillance and early intervention.

Since this patient has mutations in both copies of the MLH3 gene, it is almost certain each of their parents and all of their children carry at least one of these MLH3 mutations. Siblings are at very high risk for carrying either one or two MLH3 mutations. The cancer risk table that follows provides cancer risks for individuals with mutations in both copies (biallelic) of the MLH3 gene.   These risks do not apply to relatives who have inherited only a single MLH3 mutation (monoallelic).

References

  1. Gupta S, et al. NCCN Clinical Practice Guidelines in Oncology® Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric. V 1.2025. Jun 13. Available at https://www.nccn.org.
  2. Olkinuora A, et al. Biallelic germline nonsense variant of MLH3 underlies polyposis predisposition. Genet Med. 2019 Aug;21(8):1868-1873. PMID: 30573798.
  3. SEER*Explorer: An interactive website for SEER cancer statistics [Internet]. Surveillance Research Program, National Cancer Institute. [Cited 2025 Aug 12]. Available from https://seer.cancer.gov/explorer/.
Last Updated on 15-Sep-2025