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We present 2 sisters, ages 62 and 70, both carrying the CDH1 mutation, which is associated with significantly increased risks of HDGC and breast cancer. Both were diagnosed with invasive lobular carcinoma of the breast, a known manifestation of CDH1 mutations, emphasizing the need for genetic screening in patients with strong family cancer histories. Despite their elevated HDGC risk, the sisters declined prophylactic surgery. Instead, they pursued annual endoscopic gastro-duodenoscopies with ultrasound surveillance tailored to their needs. This case highlights the importance of recognizing rare genetic mutations and integrating family history into personalized clinical management.<\/jats:p>","DOI":"10.1177\/23247096251358660","type":"journal-article","created":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T09:46:03Z","timestamp":1758361563000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hereditary Cancer Syndromes in Familial Breast Cancer: Insights Into Proactive Gastric Cancer Surveillance"],"prefix":"10.1177","volume":"13","author":[{"given":"Jennifer","family":"Wiese","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swapna","family":"Sirigireddy","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelwahap","family":"Elghezewi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Shanti","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikayla","family":"Myers","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bassel","family":"Dakkak","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Ben Khayal","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6324-7464","authenticated-orcid":false,"given":"Thomas","family":"Wright","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wesam","family":"Frandah","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1092-3565","authenticated-orcid":false,"given":"Zakaria","family":"Alagha","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Joan Edwards School of Medicine, Erma Ora Byrd Center, Marshall University, Huntington, WV, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,20]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.epi-13-1057"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0065-230x(01)83002-5"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2009.074237"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(20)30219-9"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.7862"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13053-024-00293-5"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.10852"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.5118"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2012.1071"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2014.168"},{"key":"e_1_3_3_12_2","first-page":"204","article-title":"Hereditary diffuse gastric cancer associated with E-cadherin germline mutation: a case report","volume":"73","author":"Black MD","year":"2014","unstructured":"Black MD, Kaneshiro R, Lai JI, et al. 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