American Board of Surgery Qualifying Exam (ABS QE) Practice Test

According to the Amsterdam Criteria, how many relatives are required for a diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC) related cancers?

1. 1 relative with HNPCC associated cancers

2. 2 relatives in the same generation

3. 3 or more relatives across multiple generations

4. Only affected first-degree relatives

The correct answer is: 3 or more relatives across multiple generations

The Amsterdam Criteria, which are used to identify individuals at risk for hereditary nonpolyposis colorectal cancer (HNPCC), stipulate that for a diagnosis, there must be 3 or more relatives with associated HNPCC cancers across multiple generations. This criterion emphasizes the hereditary nature of the condition and highlights its transmission through family lines rather than isolated cases. By requiring that cancers occur in multiple relatives from separate generations, the Amsterdam Criteria aim to establish a clear pattern of inheritance that suggests a genetic predisposition. This helps clinicians to identify families that may benefit from increased surveillance and genetic counseling. The presence of 3 relatives spread across generations strengthens the argument for a hereditary syndrome as it indicates that the risk is not just incidental or due to shared environmental factors. The other options do not meet the specificity and depth of family history required by the Amsterdam Criteria, which is why they are not adequate for this diagnostic purpose.