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Several challenging pedigrees were selected from Creighton University\u2019s hereditary cancer family registry, as well as one family from Evanston\/Northwestern Healthcare, to be discussed in this present report. <\/jats:p><jats:p> Results: Many obstacles were identified in diagnosis, counseling, and managing patients at high risk for HBC\/HBOC. These obstacles were early noncancer death of key relatives, perception of insurance or employment discrimination, fear, anxiety, apprehension, reduced gene penetrance, and poor compliance. Other important issues such as physician culpability and malpractice implications for failure to collect or act on the cancer family history were identified. <\/jats:p><jats:p> Conclusion: When clinical gene testing emerged for BRCA1 and BRCA2, little was known about the efficacy of medical interventions. Potential barriers to uptake of testing were largely unexplored. Identification and referral of high-risk patients and families to genetic counseling can greatly enhance the care of the population at the highest risk for cancer. 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