The National Institute for Clinical Excellence (NICE) publishes guidelines on eligibility for BRCA testing. However, regional genetics services set their own criteria, so eligibility may vary between regions. In general, you are eligible for BRCA testing if you are classified as having a 10% or greater chance of carrying a BRCA mutation.
The following factors are likely to determine whether you are eligible:
It is important to be aware that a strong family history of breast, ovarian and or prostate cancer does not necessarily mean that there is a BRCA mutation in your family. Cancer can be caused by a number of different genetic factors in a variety of different genes.
Children under the age of 18 are usually not eligible for carrier testing for BRCA. This is because anyone having a genetic test needs to be old enough to make their own choice about whether to have the test or not. They also need to be able to fully understand all the implications that the test results may have on them and their family members.
If you would like to determine whether you are eligible for BRCA testing, talk to your GP about your family’s cancer history. If appropriate, they will refer you to your regional genetics clinic where a genetic counsellor will provide you with support and information and will discuss with you whether genetic testing is an appropriate option.
Some individuals who do not meet the criteria for testing on the NHS may be eligible for testing through the Breast and Ovarian Cancer Susceptibility Study (BOCS). Alternatively, it may be possible to pay for a test privately, although the chance of finding a BRCA mutation in these individuals is low. The resources section offers more information on private services.
If you meet the eligibility criteria for BRCA testing, you will be referred to your regional genetics service to meet with a genetic counsellor or geneticist who will discuss your risk and the test procedure with you. Before you decide whether or not to go ahead with the test, the genetic counsellor will make sure that you have good information to take away and think about and will give you the opportunity to ask questions. Having a test can have a big impact on you and other members of your family.
During the test, a small blood sample will be taken and sent to a lab. Here, scientists will extract DNA from your blood sample and analyse the genetic code of the BRCA genes to look for possible mutations. If you are of Ashkenazi origin, they will look specifically for the three genetic changes that are common in Ashkenazi Jewish people (Ashkenazi BRCA mutations) and in some labs they also look at the whole of these genes. If you have a known BRCA mutation in your family, they will look specifically for this genetic change that is known to exist in your family members’ DNA.
The test result will usually take a few weeks to months to come back. You should discuss with your genetic counsellor when to expect these as it varies between clinics. When your results arrive, you will return to the clinic to discuss them with the genetic counsellor (see section about getting your results for more information).
If you are found to be eligible for genetic testing for BRCA, your genetic counsellor will talk to you about your potential options if your test comes back positive. This conversation will help you to decide whether taking the test is the right option for you. Making a decision about whether to go ahead with the test may be difficult and lead to feelings of anxiety or fear. Thinking about the possibility of getting cancer is difficult. It may also stir up emotions you felt when other family members were diagnosed with cancer and what they went through.
Before you decide, it can help to think about how you feel about having a test, what a positive result would mean for you and if it would have an impact on your family members. Your decision may also be affected by the availability and suitability of preventative treatment and whether this is something you would consider. Remember that it is your decision to make, but talking through your options with your family and knowing how they feel may help you to make the right decision. If you decide to go ahead with testing, you will be supported by a team of specialists. You will be offered genetic counselling and you can change your mind at any time if you decide not to have a test.
If you do decide to go ahead with the test, check with your genetic counsellor about when you are likely to receive the results. It will help to have some idea, as waiting for results can be a challenging time.
Written by Jnetics.
Approved by Professor Rosalind Eeles Professor of Oncogenetics at The Institute of Cancer Research, The Royal Marsden Hospital London
Last review: 10.09.2016