Learning that hereditary cancer risk runs in your family can feel overwhelming. Understanding BRCA gene inheritance and making decisions about genetic testing involves navigating complex emotions and information. This guide will help you know who in your family should consider testing, at what age testing is most appropriate, and what criteria healthcare providers use to determine who qualifies for BRCA genetic testing.

‍

Understanding BRCA Genes

What Are BRCA1 and BRCA2 Genes?

Think of BRCA1 and BRCA2 genes as your body's tumor suppressors—they're like quality control managers that fix damaged DNA before it causes problems. When you have a BRCA gene mutation (a harmful change in the gene), these quality control managers can't do their job properly.

The result? Significantly increased cancer risk, particularly for:

• Breast cancer: Women with BRCA1 mutations have up to a 70% lifetime risk of breast cancer; BRCA2 carriers have up to 60-70% risk
• Ovarian cancer: BRCA1 carriers face up to 44% risk; BRCA2 carriers up to 17% risk
• Prostate cancer: Men with BRCA mutations have increased risk of aggressive prostate cancer
• Pancreatic cancer: Both men and women with BRCA mutations face elevated risk

But here's the critical thing to understand: having a BRCA mutation doesn't mean you'll definitely get cancer. It means your risk is higher, and there are proven strategies to manage that risk.

‍

How BRCA Mutations Are Passed Down

How Do You Inherit BRCA Mutations? Understanding the 50/50 Chance

BRCA mutations follow what geneticists call an 'autosomal dominant' pattern. Here's what that actually means for your family:

• You only need to inherit one copy of the mutated gene (from either parent) to have an increased cancer risk
• Each child of someone with a BRCA mutation has a 50% chance of inheriting the mutation
• Both men and women can inherit and pass on BRCA mutations
• The mutation can come from either your mother's or father's side of the family

Understanding your family history on both sides is crucial when assessing your hereditary cancer risk.

The Myth About BRCA Being a 'Women's Issue

One of the biggest misconceptions about BRCA testing is that it only matters for women. Not true.

Men carry and pass on BRCA mutations at the same rate as women. A father with a BRCA mutation has a 50% chance of passing it to each child—whether that child is a son or daughter. Men with BRCA mutations also face their own cancer risks, including:

• Male breast cancer (yes, men can get breast cancer)
• Aggressive prostate cancer, particularly before age 65
• Pancreatic cancer

So if your dad's side of the family has a history of breast or ovarian cancer, that's just as important as your mom's family history. Far too many people overlook paternal family history, thinking BRCA 'comes from the mother's side.' It doesn't work that way—cancer risk can be inherited from either parent.

‍

Who in Your Family Should Get BRCA Testing First?

When considering genetic testing for BRCA mutations within a family, starting with specific family members is most informative.

The Best Candidate for Initial Testing

The most effective approach is to test the person in your family who:

• Has been diagnosed with cancer – Testing someone who has had breast, ovarian, pancreatic, or high-risk prostate cancer will provide the most definitive information. If that person has a BRCA mutation, it helps explain their cancer diagnosis and identifies what specific mutation to look for in other family members.
• Had cancer at the youngest age – If multiple family members have had cancer, the person diagnosed at the youngest age often has the highest likelihood of carrying a hereditary mutation.
• Had the most BRCA-associated cancers – Someone who has had multiple cancers associated with BRCA mutations (such as both breast and ovarian cancer) is an ideal candidate for initial testing.

Once a specific BRCA mutation is identified in one family member, others can undergo much simpler and less expensive "single-site testing" that looks only for that particular mutation. It is important to note that even when a familial mutation is identified, additional testing for mutations in other genes may still be appropriate for other family members depending on their own risk factors and family history.  

What If the Family Member with Cancer Can't or Won't Get Tested?

This comes up more often than you'd think. Maybe your mom who had ovarian cancer passed away before BRCA testing was widely available. Maybe your uncle with pancreatic cancer doesn't want to know his genetic status. Maybe you're adopted and don't have access to biological family health history.

When you can't test the person who had cancer, you have two options:

1. Test the closest blood relative – This might be a sibling, child, or parent of the person who had cancer. While not as definitive as testing the affected person, it can still provide valuable information.
2. Get comprehensive multi-gene panel testing – Instead of testing only for BRCA1 and BRCA2, you can get tested for dozens of genes associated with hereditary cancer. This broader approach makes sense when you don't have a confirmed mutation in the family to test for.

jscreen's hereditary cancer test actually screens 48 genes, not just BRCA1 and BRCA2, which gives you a more complete picture of your genetic cancer risk.

‍

At What Age Should You Get BRCA Testing? Age-by-Age Guidelines

The timing of genetic testing is an important consideration that depends on when the information would impact medical management.

Recommended Testing Ages

• Adults (18+ years): Testing is generally available to any adult who meets testing criteria or has a known BRCA mutation in the family.
• Young adults (18-25 years): While testing is available, medical management recommendations typically don't begin until age 25, so some young adults wait to test until they would be able to do something with their results. 
• High-risk adults age 25-35: This is when most medical management for BRCA carriers begins, including enhanced breast screening with MRI. Many carriers choose to have testing around age 25 when they start increased surveillance.

• Women approaching age 35-40: Women with BRCA1 mutations are often advised to consider risk-reducing removal of the ovaries and fallopian tubes after completing childbearing or around age 35-40, making this another time period where testing may be particularly important.
• Children under 18: Testing is generally not recommended for minors since BRCA mutations don't typically increase childhood cancer risks, and interventions wouldn't begin until adulthood.

‍The National Comprehensive Cancer Network (NCCN) provides specific guidelines for when preventive measures should begin for BRCA carriers:

• Age 25: Begin annual breast MRI screening
• Age 30: Add annual mammogram, alternating with MRI every 6 months
• Age 35-40: Consider risk-reducing salpingo-oophorectomy (removal of ovaries and fallopian tubes) for BRCA1 carriers
• Age 40-45: Consider risk-reducing salpingo-oophorectomy for BRCA2 carriers
• Some providers will recommend screening begin ten years prior to the earliest diagnosis of cancer in the family, or at the ages listed above, whichever is earlier. 

These guidelines are based on recommendations from the National Comprehensive Cancer Network, which regularly updates medical management protocols as new research becomes available.

These guidelines help inform the appropriate timing for genetic testing based on when the results would lead to actionable medical decisions.

‍

Do You Qualify for BRCA Testing? Insurance Coverage Criteria Explained

Here's good news: if you meet certain medical criteria, your insurance will likely cover BRCA genetic testing at little to no cost. Insurance companies and healthcare providers use guidelines from the National Comprehensive Cancer Network (NCCN) to determine who qualifies.

Let's break down whether you meet the criteria—and what to do if you don't.

Personal History Criteria

You may meet the criteria for BRCA testing if you have had the following:

• Breast cancer at age 45 or younger
• Triple-negative breast cancer at age 60 or younger
• Ovarian, fallopian tube, or primary peritoneal cancer at any age
• Male breast cancer at any age
• Metastatic or high-risk prostate cancer at any age
• Pancreatic cancer at any age
• Two separate breast cancer diagnoses, especially if the first was before age 50
• Breast cancer at any age with Ashkenazi Jewish ancestry
• A known BRCA mutation in your family

Family History Criteria

You may meet the criteria for testing based on your family history if you have the following:

• Two or more close relatives with breast cancer, with at least one diagnosed before age 50
• Three or more close relatives with breast cancer at any age
• A close relative with ovarian cancer
• A close relative with male breast cancer
• A close relative with pancreatic cancer or metastatic prostate cancer
• A close family member with a known BRCA mutation
• Ashkenazi Jewish ancestry with a close relative with breast, ovarian, or pancreatic cancer

Close relatives typically include parents, siblings, children, grandparents, aunts, uncles, nieces, and nephews on the same side of the family.

Special Population Considerations

BRCA Testing for Ashkenazi Jewish Families: Why It's Especially Important

Individuals of Ashkenazi Jewish descent have a higher likelihood of carrying specific BRCA mutations:

• Approximately 1 in 40 people of Ashkenazi Jewish ancestry carry a BRCA mutation, compared to about 1 in 400 in the general population.
• Three specific BRCA mutations (founder mutations) account for most BRCA mutations in this population.
• Testing may be considered for individuals of Ashkenazi Jewish ancestry, even with a less significant family history.

Male BRCA Carriers‍

Men can carry and pass on BRCA mutations and should consider testing if:

• They have a personal history of male breast cancer, pancreatic cancer, or metastatic or high-risk prostate cancer
• They have a strong family history of BRCA-associated cancers
• They have a known BRCA mutation in the family

Remember that a man with a BRCA mutation has a 50% chance of passing it to each of his children, regardless of their gender.

What If You Don't Meet Insurance Criteria?

Maybe you don't check any of these boxes, but your gut is telling you to get tested anyway. Perhaps you have limited family health information, or your family is small (making patterns harder to spot), or you just want peace of mind.

You have options:

Self-Pay Testing: Many people choose to pay out-of-pocket for BRCA testing even without meeting insurance criteria. Through jscreen, BRCA testing (as part of a 48-gene hereditary cancer panel) is available for $249 self-pay—significantly less than the $3,000+ it might cost through some hospitals or commercial labs.

Clinical Research Studies: Some research institutions offer free or low-cost genetic testing as part of cancer prevention studies. Ask your doctor for opportunities.

Financial Assistance: jscreen offers financial assistance programs for those who qualify. Don't let cost be the only reason you skip testing if you have genuine concerns about your cancer risk.

Making the Decision

Deciding whether and when to pursue genetic testing is deeply personal. Genetic counseling is an essential part of this process and can help you:

• Understand your personal and family risk.
• Review the benefits, limitations, and possible outcomes of testing.
• Address psychological and emotional concerns.
• Navigate insurance and financial considerations.
• Develop a personalized plan for cancer screening and prevention based on results.

Through jscreen, genetic counseling is included with your testing. You're not paying extra for this support—it's built into the program.

Understanding Results

What Do BRCA Test Results Actually Look Like?

Let's walk through the three possible outcomes and what each means for you:

Positive Result: You Have a BRCA Mutation

This means you inherited a harmful mutation in BRCA1 or BRCA2. Your lifetime cancer risks are significantly elevated, but remember: elevated risk isn't a guarantee. Many BRCA carriers never develop cancer, especially those who follow enhanced screening and prevention protocols.

What happens next:

• You'll work with your doctor to create a personalized screening plan
• You'll discuss options like preventive medications or risk-reducing surgery
• Your close blood relatives (siblings, children, parents) should consider testing for the same mutation
• You'll likely qualify for more frequent and earlier cancer screening covered by insurance

Negative Result: No BRCA Mutation Detected

If your test is negative AND someone in your family already tested positive for a specific BRCA mutation, this is excellent news. You didn't inherit the family mutation, and your cancer risk is similar to the general population.

If no one in your family has tested positive, a negative result is less clear. It could mean:

• You don't carry a BRCA mutation (good news)
• You carry a mutation in a different gene not included in your test
• Someone in your family has a BRCA mutation that hasn't been identified yet

This is why testing affected family members first is so important—it provides clarity for everyone else.

Variant of Uncertain Significance (VUS)

Sometimes testing finds a genetic change, but scientists aren't sure if it's harmful or benign. This happens in about 5-10% of tests. A VUS is NOT the same as a positive result—you shouldn't make medical decisions based on a VUS. As genetic research advances, many VUS results get reclassified as benign or pathogenic.

Cost & Access

Let's talk money, because cost is one of the biggest barriers to genetic testing.

With Insurance Coverage

If you meet medical criteria for BRCA testing (see the criteria section above), most insurance plans cover testing with little to no out-of-pocket cost. Under the Affordable Care Act, insurance companies must cover BRCA testing for people who meet NCCN guidelines at no cost-sharing.

What this means: $0 copay, $0 coinsurance, even if you haven't met your deductible.

Important: Always verify coverage with your insurance company before testing. Some plans have specific requirements about which labs they'll cover or whether you need prior authorization.

Without Insurance or If You Don't Meet Criteria

If you're paying out-of-pocket, costs vary wildly:

• Hospital-based labs: $3,000-$4,000 for BRCA1 and BRCA2 testing alone
• Commercial labs: $250-$2,000 depending on the lab and test comprehensiveness
• jscreen's hereditary cancer test: $249 (includes BRCA1, BRCA2, and 46 other cancer risk genes, plus genetic counseling)

The math is simple: for less than the cost of a single BRCA-only test at some facilities, you can get comprehensive 48-gene cancer screening through JScreen.

‍

Your Next Steps: How to Get Started with BRCA Testing Today

If you're concerned about hereditary breast and ovarian cancer in your family, consider these steps:

1. Gather your family history – Document cancer diagnoses on both sides of your family, including the type of cancer and age at diagnosis.
2. Speak with your healthcare provider – Discuss your concerns and family history.
3. Consider genetic counseling – A genetic counselor can evaluate your risk and help you decide if testing is proper.
4. Understand your insurance coverage – Many insurance plans cover genetic testing for those who meet medical criteria.

For qualified individuals, Myriad Genetics offers the MyRisk Hereditary Cancer Test, which evaluates 48 genes associated with hereditary cancer risk. Various financial assistance programs are available to help make testing more accessible.

Genetic testing empowers you with information that can guide critical health decisions for you and your family. By understanding who should be tested, when testing is appropriate, and what the results mean, you can take proactive steps toward managing your hereditary cancer risk.

‍

Frequently Asked Questions About BRCA Testing

How accurate is BRCA testing?

BRCA genetic testing is highly accurate (>99%) when performed by certified labs. False positives are extremely rare. The main limitation is that current testing can only detect known mutations—if your family has an undiscovered rare mutation, it might not be detected by standard panels.

Can BRCA mutations skip a generation?

No, BRCA mutations don't skip generations in the traditional sense. However, it might appear that way. Remember, each child has a 50% chance of inheriting the mutation. If your parent carries a BRCA mutation but didn't pass it to you, you don't carry it and can't pass it to your children. However, if your parent has the mutation, your siblings might have inherited it even if you didn't.

Will BRCA testing affect my life insurance?

The Genetic Information Nondiscrimination Act (GINA) protects against genetic discrimination by health insurers and employers. However, GINA does NOT cover life insurance, disability insurance, or long-term care insurance. Some people choose to purchase life insurance before genetic testing for this reason. Discuss this with a genetic counselor if it's a concern.

What if I'm adopted and don't know my family history?

Without biological family history, comprehensive multi-gene panel testing is usually recommended over BRCA-only testing. JScreen's 48-gene panel can screen for mutations across many hereditary cancer genes, providing broader information when family history is unavailable.

Can men get BRCA testing?

Absolutely. Men can carry and pass on BRCA mutations. Men with BRCA mutations face increased risk of male breast cancer, aggressive prostate cancer, and pancreatic cancer. If you're a man with a family history of breast or ovarian cancer, BRCA testing is appropriate.

My sister tested positive for BRCA. Does that mean I have it too?

Not necessarily. Since each sibling has a 50% chance of inheriting the mutation, you might have inherited it or you might not. The only way to know is to get tested yourself—specifically for the same mutation your sister has.

How long does BRCA testing take?

Through jscreen, results typically come back in 3-4 weeks after the lab receives your sample. Some labs offer expedited processing for an additional fee.

What's the difference between BRCA1 and BRCA2 mutations?

Both increase cancer risk, but with some differences:

• BRCA1 mutations typically cause breast cancer at earlier ages than BRCA2
• BRCA1 carriers have higher ovarian cancer risk (up to 44%) vs BRCA2 (up to 17%)
• BRCA2 mutations are more strongly associated with male breast cancer and prostate cancer

The screening and prevention recommendations differ slightly between BRCA1 and BRCA2 carriers.

‍

References:

‍

‍