BRCA and Genetic Testing for Breast Cancer: Who Should Get Tested

October 10, 2026 · Breast Cancer, Cancer Prevention

A scientist works with a microscope in a laboratory. — Photo: National Cancer Institute on Unsplash

Most breast cancers aren't inherited. But some families carry gene changes that raise the risk of breast, ovarian and other cancers, and BRCA1 and BRCA2 are the best known. Knowing whether you carry one can change when you start screening, which tests you get, and the choices you have to lower your risk.

Genetic testing is simple, usually a blood or saliva sample. Deciding whether to get tested, and what to do with the results, is the harder part. Here's what to know.

What BRCA1 and BRCA2 do

Everyone has BRCA1 and BRCA2 genes. Normally they help repair damaged DNA and keep cells from growing out of control. A harmful change (also called a mutation or pathogenic variant) in one of these genes means that repair system doesn't work as well, and cancer is more likely to develop. Children of a parent with a harmful BRCA change have a 50% chance of inheriting it, and it can be passed down through either the mother's or the father's side.

How much a BRCA change raises risk

According to the National Cancer Institute:

Breast cancer: more than 60% of women with a harmful BRCA1 or BRCA2 change develop breast cancer during their lives, compared with about 13% of women overall.
Ovarian cancer: 39% to 58% of women with a BRCA1 change and 13% to 29% with a BRCA2 change, compared with about 1.1% of women overall.
Other cancers: BRCA changes also raise the risk of pancreatic cancer, prostate cancer in men (especially with BRCA2), and breast cancer in men.

These are averages. Your own risk depends on the specific change, your family history and other factors, which is one reason genetic counseling matters.

Who should consider testing

The U.S. Preventive Services Task Force recommends that women with a personal or family history of breast, ovarian, fallopian tube or peritoneal cancer, or with ancestry linked to BRCA changes, be assessed with a brief family history tool. If that assessment suggests higher risk, the next step is genetic counseling and, if appropriate, testing. The task force does not recommend routine testing for women without these risk factors.

Signs that testing may make sense include:

a relative with a known harmful BRCA1 or BRCA2 change
breast cancer diagnosed before age 50 in you or a close relative
ovarian, pancreatic, male breast or high-risk prostate cancer in you or your family
several relatives on the same side of the family with breast or ovarian cancer
Ashkenazi Jewish ancestry

If you've already been diagnosed with breast cancer, the American Society of Clinical Oncology and the Society of Surgical Oncology recommend offering BRCA1 and BRCA2 testing to everyone newly diagnosed with breast cancer at age 65 or younger, and to people diagnosed later if they have triple-negative breast cancer, a strong personal or family history, or could be treated with a PARP inhibitor. Results can affect surgery choices and which medicines may work. Men with breast cancer should be offered testing too. See our guide to breast cancer in men.

Start with genetic counseling

A genetic counselor or a doctor trained in cancer genetics can review your family history, explain what a test can and can't tell you, help choose the right test (many labs now test a panel of genes, not just BRCA1 and BRCA2), and walk you through the results. If someone in your family has already tested positive, it usually makes sense for you to be tested for that same change.

What the results can mean

Positive: you carry a harmful change and have a higher risk of certain cancers. It does not mean you will get cancer, or tell you when.
Negative: no harmful change was found. If a relative has a known BRCA change and you tested negative for it, you didn't inherit it, and your risk is usually close to average. If no one in your family has been tested, a negative result is less certain, and your family history still matters.
Variant of uncertain significance (VUS): a change was found, but it isn't yet known whether it raises risk. Most of these are eventually reclassified as harmless. Doctors usually don't base medical decisions on a VUS, so ask your counselor to let you know if it's reclassified.

If you test positive: your options

A positive result gives you options to find cancer early or lower your risk. Talk them through with your doctor; there's no single right path.

Earlier, more intensive screening, often yearly breast MRI in addition to mammograms, starting at a younger age.
Risk-reducing surgery. Removing both breasts (bilateral mastectomy) greatly lowers breast cancer risk. Removing the ovaries and fallopian tubes lowers ovarian cancer risk, but causes early menopause. Neither guarantees cancer won't develop.
Medicines. Ask your doctor whether risk-reducing medicines are an option for you. The evidence for them in BRCA carriers specifically is still limited.

There's no reliable screening test for ovarian cancer, which is why doctors often recommend removing the ovaries and tubes once a woman has finished having children.

Cost and privacy

Because the task force recommends BRCA counseling and testing for women at increased risk, most private health plans must cover them without cost sharing for women who meet the criteria. Women who had breast or ovarian cancer in the past and aren't in active treatment are generally covered too. Coverage during active treatment, and for multi-gene panels, varies, so check with your plan first.

The federal Genetic Information Nondiscrimination Act (GINA) prevents health insurers from using genetic information to set your premiums or decide eligibility, and prevents employers with 15 or more employees from using it in hiring, firing or promotion. GINA does not cover life, disability or long-term care insurance, so some people consider buying those policies before testing.

The bottom line

If breast, ovarian, pancreatic or prostate cancer runs in your family, or you've been diagnosed with breast cancer at 65 or younger, ask your doctor about genetic counseling. A test result can help you and your relatives make better decisions about screening and prevention. To find specialists, search our directory of oncologists and cancer treatment centers, and read more about breast cancer risk factors.

This article is for general information and is not medical advice. Talk with your doctor about your own situation.