Quick answer
NHS BRCA testing is free where you meet NICE criteria, which generally means a family history strong enough to give roughly a one in ten chance of carrying a variant, or certain diagnoses in your own history. Private testing removes the eligibility threshold and shortens the wait, and should always include genetic counselling.
Key takeaways
- BRCA1 and BRCA2 are genes that normally help repair DNA. A pathogenic variant in either substantially raises lifetime breast and ovarian cancer risk above the population average.
- Around one in seven women in the UK will develop breast cancer at some point. Carrying a pathogenic BRCA variant puts you well above that, and your genetics team will give you a figure for your specific variant.
- NHS testing follows NICE CG164 criteria. If you meet them it is free; if you do not, the NHS will generally not test on request alone.
- A negative result in someone with a strong family history does not eliminate risk. Most familial breast cancer is not explained by BRCA1 or BRCA2.
- A positive result opens real options: enhanced surveillance with MRI, risk-reducing surgery, and chemoprevention.
- The result affects your relatives too. Testing is a family decision as much as a personal one, which is why counselling is part of the process rather than an add-on.
BRCA testing is one of the few areas of breast care where the test itself is the easy part. Taking the sample is trivial. Deciding whether to have it, interpreting what comes back, and working out what to do about it are where the substance lies, and that is why every reputable pathway wraps the test in counselling.
What do BRCA1 and BRCA2 actually do?
They are tumour suppressor genes. Their normal job is to help repair breaks in DNA, which happen constantly in dividing cells. When one copy carries a pathogenic variant, that repair machinery works less well, damage accumulates, and the chance of a cell becoming cancerous over a lifetime rises. The effect is strongest in breast and ovarian tissue, and BRCA2 variants also raise prostate and pancreatic cancer risk.
Two points patients regularly get wrong. First, this is not a diagnosis of cancer — it is a change in probability, and plenty of carriers never develop cancer. Second, men carry and pass on these variants exactly as women do, so a father’s family history counts just as much as a mother’s.
Who qualifies for NHS BRCA testing?
NICE guideline CG164 governs this. Broadly, you are likely to meet the threshold if:
- A pathogenic BRCA variant has already been identified in a relative
- You have had breast cancer at a young age, triple-negative breast cancer, or ovarian cancer
- You are a man who has had breast cancer
- You have multiple close relatives with breast or ovarian cancer, particularly diagnosed young or affecting both breasts
- You have Ashkenazi Jewish ancestry together with a personal or family history of breast or ovarian cancer
Your GP or a specialist refers you to a regional genomics service, which assesses your family history against the criteria before testing. If you meet them, testing and counselling are free.
What does private BRCA testing add?
Two things: access if you do not meet NHS criteria but want to know, and speed. Regional genomics services carry waiting lists, and for someone facing a treatment decision now — whether to have a wider operation, for instance — the timing can matter clinically rather than just emotionally.
What it should not do is skip the counselling. A panel test that comes back with a variant of uncertain significance, which happens, is actively harmful without someone qualified to explain that an uncertain variant is not an actionable one. Our BRCA genetic testing pathway includes that conversation before the sample is taken as well as after the result.
What changes if the result is positive?
A pathogenic result moves you into a surveillance and prevention pathway rather than a treatment one. The realistic options are:
Enhanced surveillance. Annual MRI is typically offered from age 30 for those at high risk, with mammography added from 40. MRI is used because it is more sensitive than mammography in the dense breast tissue common at that age.
Risk-reducing mastectomy. Removing breast tissue before any cancer develops substantially lowers, though does not entirely eliminate, future risk. It is a considered decision taken over months, usually with reconstruction planned at the same time.
Risk-reducing removal of the ovaries and fallopian tubes. Recommended after childbearing is complete, and the single most effective intervention for ovarian risk, which mammography and MRI cannot screen for reliably.
Chemoprevention. Tamoxifen or anastrozole for a defined period reduces the incidence of hormone-receptor-positive breast cancer in people at increased risk.
NHS or private: which route suits you?
| NHS route | Private route | |
|---|---|---|
| Who can be tested | Those meeting NICE CG164 criteria | Anyone who wants testing after counselling |
| Cost | Free where criteria are met | Paid; fees quoted on enquiry as panels and laboratories differ |
| Counselling | Included, before and after | Should be included — check that it is |
| Typical wait | Weeks to months, varying by region | Days to weeks |
| Cascade testing for relatives | Arranged through the genomics service, free for eligible relatives | Relatives can usually be tested free on the NHS once a familial variant is confirmed |
| Best suited to | Anyone who meets the criteria and is not under time pressure | Those outside the criteria, or facing a treatment decision now |
“The result is the beginning of a conversation, not the end of one. What I want people to have before they test is a clear idea of what they would do with each possible answer.”
Mr Debashis Ghosh, Consultant Breast and Oncoplastic Surgeon
If you are weighing up testing, or you have had a result elsewhere and want it interpreted, a consultation is the place to start. We also assess breast symptoms in the same visit through our same-day one-stop breast clinic, and we see our clinic for Chelsea patients alongside patients from across London.
BRCA testing: frequently asked questions
How much does private BRCA testing cost in the UK?
It varies considerably with the laboratory and the size of the gene panel, and prices change, so any figure quoted online should be confirmed directly. What matters as much as the fee is whether pre-test and post-test genetic counselling is included, because a result without interpretation is of limited use.
Can I ask my GP for a BRCA test?
You can ask for a referral for family history assessment. Whether testing follows depends on whether your history meets the NICE CG164 threshold. If it does not, the NHS will generally not test, and private testing is the remaining route.
If my BRCA test is negative, does that mean I am not at risk?
No. It means you do not carry a pathogenic variant in the genes tested. Most familial breast cancer is not explained by BRCA1 or BRCA2, so if your family history is strong you may still qualify for enhanced surveillance on the strength of that history alone.
What is a variant of uncertain significance?
A change in the gene sequence that is not clearly harmless and not clearly harmful on current evidence. It is not a positive result and should not trigger risk-reducing surgery. Classification sometimes changes as more data accumulates, which is why these results are kept under review rather than acted upon.
Do men need BRCA testing?
Men can carry and pass on BRCA variants, and BRCA2 in particular raises male breast and prostate cancer risk. A man who has had breast cancer generally meets testing criteria, and a man in a family with a known variant may want testing both for his own surveillance and for his children.
Does a positive result mean I have to have surgery?
No. Risk-reducing surgery is one option among several, and many carriers choose enhanced surveillance instead, sometimes for years before revisiting the question. It is a decision taken over time with a specialist team, and there is no requirement to decide quickly.
Will a BRCA result affect my insurance?
Under the UK agreement between the government and the Association of British Insurers, insurers do not ask for or use predictive genetic test results for life insurance below a high value threshold, with a specific exception for Huntington disease. Check the current position before testing if this concerns you.
Related reading: Breast Implant Rupture: Symptoms, Scans and What to Do Next
Thinking about genetic testing?
Consultant-led assessment of your family history, with counselling before any test and a clear plan whatever the result.
Sources
- NICE CG164 — Familial breast cancer. testing criteria, surveillance ages and risk-reducing options
- Cancer Research UK — Inherited cancer genes and increased risk. what BRCA1 and BRCA2 variants mean for risk
- NHS — Predictive genetic tests for cancer risk genes. how NHS testing and counselling work
- Association of British Insurers — Code on Genetic Testing and Insurance. how predictive test results may and may not be used
This article provides general information and does not replace personalised medical advice, diagnosis or treatment. If you have a breast symptom that concerns you, arrange an assessment.
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