NF1 gene - Cancer risk, management, and testing for genetic mutations

Associated Syndrome Name: Neurofibromatosis 1

NF1 Summary Cancer Risk Table

Cancer Genetic Cancer Risk
BreastHigh Risk
EndocrineHigh Risk
OtherHigh Risk

NF1 gene Overview

Neurofibromatosis 1 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14
  • Individuals with NF1 mutations have Neurofibromatosis 1 (NF1).
  • Individuals with NF1 are at an increased risk of developing breast cancer. This risk is especially pronounced under the age of 50 and those diagnosed tend to have a worse prognosis than those with sporadic (non-hereditary) breast cancers.
  • Individuals with NF1 also have an increased risk for cancers of the nervous system, including malignant peripheral nerve sheath tumors (MPNSTs) and tumors of the adrenal gland (pheochromocytomas). These cancers are extremely rare in the general population but should be considered in individuals with NF1 who are symptomatic or have other high risk factors. It is important for children and adults with NF1 to be followed and monitored regularly by specialists with expertise in the condition.
  • Some studies have described a possible increased risk for a wide range of other cancers in individuals with NF1 mutations, including male breast cancer, childhood leukemia, and sarcomas. However, these studies are not conclusive and there are currently no medical management guidelines to address these possible risks.
  • Individuals with NF1 often have a wide variety of other, non-cancerous features associated with this condition, many of which require medical attention. Benign tumors can occur throughout the body (i.e., neurofibromas, gliomas), including in the skin, brain, eyes, or nervous system. Other common issues in individuals with NF1 include hypertension; skeletal problems such as dysplasia, scoliosis, or osteoporosis; and neuropsychiatric conditions such as learning difficulties or behavioral disorders.
  • Although there are increased risks for cancer and a high risk for other medical problems in individuals with NF1, these risks can be managed with appropriate medical care. Guidelines from the National Comprehensive Cancer Network (NCCN), American Association for Cancer Research (AACR), and the American College of Medical Genetics and Genomics (ACMG) are listed below. Since NF1 is a complex condition, individuals with NF1 mutations and a diagnosis of NF1 should be managed by a multidisciplinary team with expertise in medical genetics and the prevention and treatment of the complications associated with this condition.

NF1 gene Cancer Risk Table

Cancer Type Age Range Cancer Risk Risk for General Population
Overall Cancer RiskTo age 507, 8, 920%-39%4.7%
To age 707, 8, 9, 1536%-60%19.8%
Female BreastTo age 503, 1510%2.2%
To age 703, 1524%7.6%
Malignant Peripheral Nerve Sheath Tumors (MPNST)Lifetime risk48%-13%<0.1%
PheochromocytomaLifetime risk5, 6Up to 15%<0.1%
Other - Non-malignant features of NF1All ages10, 11, 12NF1 is associated with non-malignant clinical features, some of which may require medical intervention as early as infancy (see Overview).NA

NF1 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)
Female BreastMammogram12, 1330 yearsAnnually
Consider breast MRI with and without contrast.12, 1330 yearsAnnually until age 50
Consider additional risk-reduction strategies.13IndividualizedNA
Malignant Peripheral Nerve Sheath Tumors (MPNST)Patient education about the signs and symptoms of MPNST12IndividualizedNA
Whole-body MRI14, 16Baseline between 16 to 20 yearsNA
PheochromocytomaThere are currently no specific medical management recommendations for pheochromocytoma risk in asymptomatic mutation carriers.NANA
Other - Non-malignant features of NF1Multiple screenings recommended, which may include comprehensive physical exam, skin exam, eye exam, neurological exam, blood pressure monitoring, and evaluations for neuropsychiatric disorders.11, 12, 16At time of diagnosis of NF1Varies

Benefits of Testing for NF1 Gene Mutations:

Testing for NF1 gene mutations with the MyRisk® Hereditary Cancer Test with RiskScore® provides critical insights to patients and providers about potential hereditary cancer risk. Identifying a NF1 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 NF1 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 NF1 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.

It is appropriate to offer genetic counseling to individuals with NF1 who are of reproductive age to discuss reproductive risks and options. There are additional considerations before and during pregnancy for individuals with NF1.10, 12

Approximately half of individuals with NF1 have not inherited the NF1 mutation from a parent. In these cases, the mutation has developed spontaneously in that individual (a de novo mutation). Once this occurs, the children of that individual are each at 50% risk of inheriting the mutation.10

Since NF1 mutations carry a risk for complications in children, consideration should be given to mutation testing in childhood.10, 11

References

  1. Madanikia SA, et al. Increased risk of breast cancer in women with NF1. Am J Med Genet A. 2012 Dec;158A(12):3056-60. PMID: 23165953.
  2. Suarez-Kelly LP, et al. Increased breast cancer risk in women with neurofibromatosis type 1: a meta-analysis and systematic review of the literature. Hered Cancer Clin Pract. 2019 Mar 25;17:12. PMID: 30962859.
  3. Seminog OO, Goldacre MJ. Age-specific risk of breast cancer in women with neurofibromatosis type 1. Br J Cancer. 2015 Apr 28;112(9):1546-8. PMID: 25742481.
  4. Evans DG, et al. Malignant peripheral nerve sheath tumours in neurofibromatosis 1. J Med Genet. 2002 May;39(5):311-4. PMID: 12011145.
  5. Zinnamosca L, et al. Neurofibromatosis type 1 (NF1) and pheochromocytoma: prevalence, clinical and cardiovascular aspects. Arch Dermatol Res. 2011 Jul;303(5):317-25. PMID: 21042801.
  6. Walther MM, et al. von Recklinghausen's disease and pheochromocytomas. J Urol. 1999 Nov;162(5):1582-6. PMID: 10524872.
  7. Uusitalo E, et al. Distinctive Cancer Associations in Patients With Neurofibromatosis Type 1. J Clin Oncol. 2016 Jun 10;34(17):1978-86. PMID: 26926675.
  8. Walker L, et al. A prospective study of neurofibromatosis type 1 cancer incidence in the UK. Br J Cancer. 2006 Jul 17;95(2):233-8. PMID: 16786042.
  9. Landry JP, et al. Comparison of Cancer Prevalence in Patients With Neurofibromatosis Type 1 at an Academic Cancer Center vs in the General Population From 1985 to 2020. JAMA Netw Open. 2021 Mar 1;4(3):e210945. PMID: 33734413.
  10. Friedman JM. Neurofibromatosis 1. 2025 Apr 3. In: Adam MP, et al., editors. GeneReviews® [Internet]. PMID: 20301288.
  11. Miller DT, et al; COUNCIL ON GENETICS; AMERICAN COLLEGE OF MEDICAL GENETICS AND GENOMICS. Health Supervision for Children With Neurofibromatosis Type 1. Pediatrics. 2019 May;143(5):e20190660. PMID: 31010905.
  12. Stewart DR, et al. Care of adults with neurofibromatosis type 1: a clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2018 Jul;20(7):671-682. PMID: 30006586.
  13. Daly M et al. NCCN Clinical Practice Guidelines in Oncology®: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. V 1.2026. Jul 10. Available at https://www.nccn.org.
  14. Greer MC, et al. Update on Whole-Body MRI Surveillance for Pediatric Cancer Predisposition Syndromes. Clin Cancer Res. 2024 Nov 15;30(22):5021-5033. PMID: 39287924.
  15. 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/.
  16. Perrino MR, et al. Update on Pediatric Cancer Surveillance Recommendations for Patients with Neurofibromatosis Type 1, Noonan Syndrome, CBL Syndrome, Costello Syndrome, and Related RASopathies. Clin Cancer Res. 2024 Nov 1;30(21):4834-4843. PMID: 39196581.
Last Updated on 15-Sep-2025