Best hereditary cancer risk tools 2026: CanRisk, BRCAPRO, Tyrer-Cuzick, and more
A 2026 guide to hereditary cancer risk tools — reference models, clinical platforms that run them, and patient-facing calculators — ranked honestly by what they do best.
Short version. For BOADICEA-based breast and ovarian risk, CanRisk from Cambridge is the reference — we are not going to pretend otherwise. For BRCAPRO, MMRpro, and PancPRO, BayesMendel from Harvard is the reference suite. For Tyrer-Cuzick (IBIS), the Tyrer-Cuzick calculator. For Gail, the NCI tool. For running most of these at once on one pedigree, FamGenix leads commercially. For BayesMendel integration inside a clinical pedigree platform with AI interpretation, Evagene. For patient-facing tools, Ovarian Cancer Action, Ohio State Family Health Risk Calculator, and Ask2Me each fit different niches.
Hereditary cancer risk is a category where the right answer depends on which model your clinical question calls for, whether the tool needs to live alongside a clinical record, and whether the user is a clinician or a patient. We have tried not to flatten that into a single ranking.
How we evaluated
- Model authority. Is this the reference implementation of the underlying model?
- Guideline endorsement. NICE, NCCN, ESMO, or other guideline bodies that reference the tool.
- Audience. Clinician, counsellor, patient, researcher.
- Integration. Does it work alongside a pedigree platform or only standalone?
- Free vs paid. Cost and access barrier.
- Covered cancers. Breast, ovarian, colorectal (Lynch), pancreatic, prostate, other.
- Longitudinal use. Does it support running the model repeatedly as family history updates?
The tools, ranked by use case
1. CanRisk — reference BOADICEA implementation
CanRisk is the Cambridge web interface to the BOADICEA breast and ovarian cancer risk model and CanRisk-Prostate. Free with registration. Backed by the University of Cambridge, Cancer Research UK, Wellcome, and Genome Canada. Endorsed by NICE, NCCN, and ESMO. Available in seven languages. The reference tool for BOADICEA-based risk. For any BOADICEA question, this is where the field goes.
Where it struggles: it is a risk calculator with a pedigree front-end, not a longitudinal clinical pedigree platform. Use it alongside a pedigree tool, not instead. Price: free with registration. Best for: breast and ovarian risk consultation, BOADICEA-based research, hereditary prostate cancer risk.
2. BayesMendel (BRCAPRO, MMRpro, PancPRO) — reference Bayesian Mendelian suite
The BayesMendel suite from Harvard is the reference Bayesian Mendelian suite for hereditary cancer. BRCAPRO calculates carrier probability for BRCA1/BRCA2 and downstream breast and ovarian cancer risks. MMRpro covers Lynch syndrome (MLH1, MSH2, MSH6) with colorectal and endometrial risk. PancPRO covers pancreatic cancer risk. These are peer-reviewed reference models, used in research and clinical practice.
Where it struggles: not a consumer-friendly tool. Accessed through R packages and clinical platforms that integrate them (Evagene, Progeny, FamGenix). Not typically used standalone at the clinical front line. Price: the R package is free; commercial platforms that integrate it are priced separately. Best for: clinical services using Lynch or pancreatic cancer risk, research.
3. Tyrer-Cuzick (IBIS) — reference breast cancer with full family history
The Tyrer-Cuzick (IBIS) breast cancer risk calculator incorporates family history more comprehensively than Gail, and is the model of choice in many breast services when meaningful family history is present. Now in v8. Widely cited in guidelines.
Where it struggles: breast-only focus; no Lynch or pancreatic coverage. Like CanRisk, best paired with a pedigree platform for longitudinal use. Price: free access via IBIS tool. Best for: breast-risk assessment with detailed family history, particularly where BOADICEA is unavailable or unfamiliar to the service.
4. Gail model (NCI) — authoritative but simpler
The Gail model, published by the National Cancer Institute, is a simpler breast cancer risk model widely used in US screening contexts. Authoritative and widely cited, it incorporates less family history than Tyrer-Cuzick or BOADICEA and is best suited to population screening rather than detailed hereditary assessment.
Where it struggles: limited family history treatment. Not appropriate as the sole model when meaningful family history is present. Price: free. Best for: US population screening, basic breast risk assessment where detailed family history is not the dominant input.
5. FamGenix — widest model coverage in one platform
FamGenix runs BOADICEA v6, Tyrer-Cuzick v8, BayesMendel, Gail, Claus, and QRISK3 simultaneously from one pedigree. Used at 4 of the top 10 US cancer centres. HIPAA and GINA compliant with regional data residency. A free Individual tier plus a paid Provider Portal.
Where it struggles: Provider Portal pricing is on application; narrower outside cancer. Price: free Individual; Provider Portal on application. Best for: clinical services wanting every major cancer model available without per-model platform switching. See FamGenix vs Evagene.
6. Evagene — BayesMendel + AI interpretation + batch screening
Evagene (our product) integrates BRCAPRO, MMRpro, and PancPRO from BayesMendel, plus Mendelian inheritance models for non-cancer monogenic conditions. A 200+ disease catalogue with ICD-10 and OMIM. Batch risk screening across the full catalogue flags cases that cross configurable thresholds. AI interpretation with BYOK LLMs (Anthropic Claude, OpenAI GPT). An MCP server for agentic AI workflows in Claude Desktop and Claude Code.
Where we struggle for pure cancer risk: we do not run Tyrer-Cuzick or native BOADICEA today. For services that need those models specifically, CanRisk or FamGenix is a better model fit. For BayesMendel-first services wanting AI interpretation alongside, Evagene is the uniquely strong current pick. Price: free Alpha via waiting list. Best for: services adopting BayesMendel with AI-assisted clinical interpretation.
7. Ovarian Cancer Action — best UK patient-facing tool
Ovarian Cancer Action runs a free UK hereditary cancer risk checker aimed at over-18s in the UK. A patient-facing triage tool that helps users decide whether to speak to their GP about hereditary cancer risk. Not a clinician tool.
Where it struggles: UK-only, over-18s only, screening-triage rather than diagnostic. Price: free. Best for: UK adults wondering whether their family history warrants GP referral.
8. Ohio State Family Health Risk Calculator — best cancer + heart combined tool
Ohio State Family Health Risk Calculator is a free tool combining cancer and heart disease family-history risk assessment. A unique combination — most tools cover one or the other, not both. Suitable for patient or primary care use.
Where it struggles: US-centric, not a specialist oncology tool. Price: free. Best for: patients or primary care wanting combined cardiovascular and cancer screening guidance.
9. Ask2Me — best variant-specific cancer risk calculator
Ask2Me is a free calculator for the specific cancer risks associated with DNA test variants. A clinician and patient tool used when a specific variant has been reported and one wants to know what cancer risks it carries.
Where it struggles: variant-specific rather than population- or family-history-based. Complements rather than replaces the reference models above. Price: free. Best for: post-test counselling on specific reported variants.
Comparison matrix
| Tool | Breast | Ovarian | Colorectal | Pancreatic | Audience | Free |
|---|---|---|---|---|---|---|
| CanRisk (BOADICEA) | ✓ | ✓ | — | — | clinician | ✓ |
| BRCAPRO (BayesMendel) | ✓ | ✓ | — | — | clinician / research | R package |
| MMRpro (BayesMendel) | — | — | ✓ | — | clinician / research | R package |
| PancPRO (BayesMendel) | — | — | — | ✓ | clinician / research | R package |
| Tyrer-Cuzick (IBIS) | ✓ | — | — | — | clinician | ✓ |
| Gail (NCI) | ✓ | — | — | — | clinician / screening | ✓ |
| FamGenix | ✓ | ✓ | some | some | clinician + patient | ✓ Individual |
| Evagene | BRCAPRO | BRCAPRO | MMRpro | PancPRO | clinician | ✓ Alpha |
| Ovarian Cancer Action | triage | triage | triage | — | patient | ✓ |
| Ohio State | some | some | some | — | patient + primary care | ✓ |
| Ask2Me | variant | variant | variant | variant | clinician + patient | ✓ |
Which to choose if...
- You need BOADICEA breast and ovarian risk: CanRisk.
- You need Lynch syndrome risk: MMRpro (via Evagene or a BayesMendel-integrating platform).
- You need pancreatic cancer risk: PancPRO (via Evagene or a BayesMendel-integrating platform).
- You want Tyrer-Cuzick breast risk with full family history: the Tyrer-Cuzick (IBIS) calculator or a platform that integrates it (FamGenix, Progeny).
- You want every major cancer risk model from one pedigree: FamGenix.
- You want BayesMendel plus AI interpretation in a clinical pedigree platform: Evagene.
- You are a UK patient wondering whether to see your GP: Ovarian Cancer Action.
- You want cancer + heart disease combined family screening: Ohio State Family Health Risk Calculator.
- You have a specific reported variant and want to know its cancer risks: Ask2Me.
- You need a longitudinal clinical record running these models over time: a pedigree platform (Progeny, Phenotips, FamGenix, TrakGene, Evagene) with the risk models integrated.
Frequently asked questions
What is the best hereditary cancer risk tool?
Depends on the model: CanRisk for BOADICEA, BayesMendel (BRCAPRO, MMRpro, PancPRO) for those specific syndromes, Tyrer-Cuzick for full-family-history breast risk, Gail for US screening. FamGenix runs most of them together; Evagene integrates BayesMendel with AI interpretation.
Is CanRisk the best for BOADICEA?
Yes — the Cambridge reference, NICE/NCCN/ESMO endorsed, free with registration.
What is BayesMendel?
Harvard-developed Bayesian Mendelian cancer risk suite: BRCAPRO, MMRpro, PancPRO. Evagene integrates all three.
Patient-facing cancer risk tools?
Ovarian Cancer Action (UK), Ohio State Family Health Risk Calculator (US), Ask2Me (variant-specific).
Widest model coverage?
FamGenix: BOADICEA v6, Tyrer-Cuzick v8, BayesMendel, Gail, Claus, QRISK3 simultaneously.
Tyrer-Cuzick vs Gail?
Tyrer-Cuzick incorporates family history more comprehensively. Gail is simpler and widely used in US screening. Complementary, not substitutes.
Do I need a pedigree tool alongside?
For ongoing clinical work, yes. Reference calculators do not store family history as a living clinical record. A pedigree platform maintains the pedigree longitudinally and runs risk models against it over time.