NHS BRCA and Breast Cancer Genetic Testing: Who Qualifies?

If your mum, sister, grandmother or another relative has had breast cancer, you might have wondered whether it could run in your family.

And if it does, could you have genetic testing on the NHS?

The answer depends on your family history, the ages at which relatives developed cancer and sometimes the type of breast cancer they had.

But there’s something important that many people don’t realise. You don’t need a family history of breast cancer to carry an inherited cancer-risk gene. And inherited risk can come from your dad’s side of the family just as easily as your mum’s.

Research suggests that traditional family-history-based testing criteria can miss around half of people carrying certain inherited breast and ovarian cancer-risk variants.

In this guide, I’ll explain who may qualify for NHS testing, when you should ask for a referral and what you can do if an inherited risk is found.

Which family histories might qualify for NHS assessment?

NICE guidance lists several patterns of breast cancer in a family that should prompt a referral for specialist breast risk assessment.

These include:

• Your mum, sister or daughter developed breast cancer before age 40.
• Your dad, brother or son developed breast cancer at any age. Breast cancer in men is unusual and can be an important clue to inherited risk.
• Your mum, sister or daughter developed cancer in both breasts, with the first cancer diagnosed before age 50.
• Two close relatives have had breast cancer, such as your mum and sister, or your mum and grandmother.
• There has been both breast and ovarian cancer in your family, particularly on the same side.
• Three or more close relatives have had breast cancer, even if they were diagnosed at older ages.

These are simplified examples from NICE guidance on familial breast cancer. The exact family relationships and ages matter, and a specialist will consider the overall pattern.

Other situations can also justify seeking advice, including a strong history of cancer on your dad’s side, Jewish ancestry or a known inherited cancer-risk gene in the family.

How can breast cancer be inherited?

Yes. Although most breast cancers aren’t caused by an inherited high-risk gene change, around 5–10% are thought to be hereditary.

The best-known genes are BRCA1 and BRCA2, but they’re not the only ones.

Other genes, including PALB2, ATM, CHEK2 and TP53, can also increase breast cancer risk.

Some inherited gene changes can increase the risk of other cancers too.

For example, BRCA2 is associated with breast, ovarian, prostate and pancreatic cancer. This is why it’s worth telling your doctor about other cancers in your family, not just breast cancer.

You can inherit a cancer-risk gene from either parent. And someone can carry that genetic change without ever developing cancer themselves.

Does being referred mean I’ll definitely be offered genetic testing?

Not necessarily.

A breast family history clinic can assess your risk, consider whether you would benefit from earlier screening and decide whether genetic testing would be useful.

Genetic testing has separate eligibility criteria. These may depend on your personal and family history, calculated risk and whether someone in your family who has already had cancer is available for testing.

Even if you’re not offered genetic testing, a family history assessment may still lead to additional breast screening.

That’s an important distinction. Getting your risk assessed can be worthwhile even when the answer isn’t a genetic test.

What if you don’t have a family history of breast cancer?

You can still carry an inherited cancer-risk gene, even if nobody in your family has ever had breast cancer.

And you certainly don’t need to have a mother who has had breast cancer.

These genes can be passed down through either parent, and someone can carry a genetic change without ever developing cancer themselves.

The problem is that family history isn’t a foolproof way of identifying inherited cancer risk.

Research suggests that around half of people carrying certain inherited breast and ovarian cancer-risk variants don’t meet traditional family-history-based testing criteria.

There are several reasons for this. Families may be small, relatives may have died young from other causes, or the gene may have been passed down through several men who never developed breast cancer.

So having no family history doesn’t necessarily mean you’re not at risk.

Some people can qualify for NHS testing without a family history because of their own cancer diagnosis, a known genetic change in the family or particular ancestry-related risks.

Private inherited cancer genetic testing is also available to people who don’t meet NHS criteria.

A consultation before testing can help you understand what the results might tell you and how they could influence your future care.

Can your ancestry increase your inherited breast cancer risk?

Yes. Certain inherited BRCA gene changes are more common in some populations, even when there is no family history of cancer.

Jewish ancestry and BRCA testing

Around 1 in 40 people with Ashkenazi Jewish ancestry carry an inherited BRCA1 or BRCA2 gene change, compared with approximately 1 in 250 people in the general UK population.

The NHS Jewish BRCA Testing Programme offered free testing to eligible adults in England with Jewish ancestry, including people without a personal or family history of cancer.

The original programme is now closed to new registrations, but NHS England is working towards a longer-term service, anticipated in 2027.

If you have Jewish ancestry, you can register your interest in future NHS BRCA testing.

If you’ve already had breast or ovarian cancer, or have a relevant family history, speak to your GP rather than waiting for the programme to reopen. You may qualify for testing through another NHS pathway.

Westray and Whalsay ancestry

Researchers have also identified inherited BRCA gene changes that are more common in people with ancestry from Westray in Orkney and Whalsay in Shetland.

A new NHS testing programme is planned for 2027 for eligible people living in Scotland who have at least one grandparent from either island.

The programme will look for a specific BRCA1 change associated with Westray ancestry or a BRCA2 change associated with Whalsay ancestry.

These genetic changes can increase breast and ovarian cancer risk, and the BRCA2 change can also increase prostate cancer risk.

You can find out more about the planned NHS BRCA testing programme through Viking Genes.

Both programmes are examples of how looking at ancestry, rather than family history alone, can help identify people with inherited cancer risk before they develop cancer.

Does triple-negative breast cancer qualify for genetic testing?

Triple-negative breast cancer is a type of breast cancer where the cancer cells don’t have three receptors that doctors commonly use to guide treatment: oestrogen receptors, progesterone receptors and HER2.

It’s called triple-negative because all three are absent.

Why does this matter for genetic testing?

Triple-negative breast cancer is more strongly associated with inherited BRCA1 changes than many other types of breast cancer.

NICE recommends offering BRCA1 and BRCA2 testing to women diagnosed with triple-negative breast cancer before age 50, even if nobody else in their family has had breast or ovarian cancer.

NHS England’s genomic testing pathways also include some people diagnosed with triple-negative breast cancer before age 60.

If you or a relative has had triple-negative breast cancer, it’s worth asking the treating cancer team whether inherited genetic testing has been offered.

The result may be useful for treatment decisions and for understanding whether other family members could be at risk.

Should an older negative BRCA test be reviewed?

Yes, particularly if the test was done several years ago.

Genetic testing has changed enormously over the past decade.

Older tests often looked only at BRCA1 and BRCA2. Some also used methods that couldn’t identify every type of genetic change.

We now know that several other genes, including PALB2, ATM and CHEK2, can also contribute to inherited breast cancer risk.

A negative BRCA result from years ago doesn’t necessarily mean all relevant inherited cancer risks have been ruled out.

Studies looking at people who previously tested negative for BRCA1 and BRCA2 have found additional inherited cancer-risk variants in around 6–10% of selected patients when testing was repeated using newer or broader methods.

For example, a 2025 study found additional clinically relevant pathogenic variants in 8.1% of participants who had previously received negative BRCA1/2 results.

These were selected people undergoing further assessment, so the figures don’t mean that everyone with an older negative test has an 8% chance of receiving a positive result.

If you or a relative had genetic testing before around 2017, it’s particularly worth finding out which genes and methods were used.

You could ask:

“I had BRCA testing several years ago and was told it was negative. Would it be worth checking whether the test covered everything we now know about inherited breast cancer risk?”

Updated testing isn’t necessary for everyone, but reviewing an older result may be worthwhile, especially when there’s a strong family history or new cancers have been diagnosed since the original test.

What should I ask my NHS GP?

If breast cancer runs in your family, it’s worth making an appointment with your GP to discuss whether you would benefit from a specialist breast risk assessment.

You don’t need a perfect family tree or a detailed understanding of genetics before asking.

You could simply say:

“My mum/sister/grandmother had breast cancer, and I’m wondering whether I might be at higher risk. Could you check whether I qualify for a family history clinic or genetic testing?”

Before your appointment, try to find out:

• Which relatives have had breast cancer, on either side of your family.
• Roughly how old they were when diagnosed.
• Whether anyone had cancer in both breasts.
• Whether anyone had triple-negative breast cancer or male breast cancer.
• Whether there have been ovarian, pancreatic or prostate cancers in the family.
• Whether relatives have already had genetic testing and what the results showed.

If a relative has had breast cancer and is still alive, it may be more useful for them to have genetic testing first. This is because testing someone who has actually had cancer can often give the family a clearer answer.

If you’re told you don’t meet NHS genetic testing criteria, you can still ask whether your family history warrants earlier breast screening or another form of risk assessment.

Our guide to collecting your family history of cancer can help you get started.

What happens if an inherited breast cancer risk is found?

Finding out you carry an inherited cancer-risk gene can feel frightening. But knowing about it can also give you opportunities to reduce your risk or find cancer much earlier.

And in the UK, there are some excellent NHS services available for people with a confirmed high inherited risk.

Earlier screening through the NHS Very High Risk Programme

One of the most important benefits of identifying an inherited breast cancer risk is being able to access earlier and more intensive screening.

The NHS has an excellent programme for women at very high risk of breast cancer.

Women with certain inherited genetic changes, including BRCA1, BRCA2 and PALB2, may qualify for annual breast MRI scans from age 25, with mammograms added later according to age and individual risk.

MRI is particularly useful in younger women, whose breasts are often denser, making cancers more difficult to detect with mammography alone.

Other inherited genes and very high-risk family histories can also qualify for enhanced surveillance.

But there’s a major problem: most people carrying these inherited risks don’t know they have them.

Research looking at BRCA carriers in London estimated that more than 97% of carriers in the general population had not been identified at the time of the study.

Although this isn’t a current estimate for the whole UK, it highlights the scale of the problem.

Many people who could benefit from earlier screening and cancer prevention may never know they’re eligible.

This is why identifying inherited cancer risk before someone develops cancer matters so much.

Medicines that can reduce breast cancer risk

For some women at increased risk, medication can help reduce the chance of developing breast cancer.

NICE recommends preventative medicines such as tamoxifen for certain premenopausal women and anastrozole for certain postmenopausal women.

These medicines aren’t suitable for everyone, and the benefits and possible side effects need to be considered carefully.

A specialist can help you understand whether medication would be appropriate for your particular risk.

Risk-reducing surgery

For women at very high inherited risk, risk-reducing mastectomy may also be an option.

This can substantially reduce breast cancer risk, but it’s a major and very personal decision.

A specialist team can discuss the expected benefits, reconstruction options and the physical and emotional implications.

Certain inherited gene changes also increase ovarian cancer risk, so some women may need to consider ways to reduce that risk too.

Lifestyle still matters

Even when someone carries an inherited cancer-risk gene, lifestyle still matters.

Being physically active, maintaining a healthy weight, limiting alcohol and avoiding smoking can support long-term health and may reduce some cancer risks.

These steps don’t remove inherited risk and aren’t a replacement for appropriate screening or prevention, but they’re still important.

And of course, inherited genes aren’t the only things that influence breast cancer risk. Age, breast density, reproductive history, hormone exposure and other factors can all make a difference.

For more information, read our guide to breast cancer risk factors, screening and prevention.

What about your family?

If a specific inherited genetic change is found, adult relatives can usually be offered testing to find out whether they carry the same change.

Those who have inherited it can access appropriate screening and prevention. Those who haven’t inherited the family’s identified variant may be able to avoid unnecessary extra screening, depending on their other risk factors.

Finding an inherited cancer-risk gene doesn’t mean you’ll develop cancer. It means you have more information and more choices about your future health.

Genetic testing referrals for healthcare professionals

If you’re a breast surgeon, breast physician, gynaecologist, oncologist or other healthcare professional caring for patients concerned about inherited breast cancer risk, we can help.

Family history is an important part of assessing cancer risk, but it doesn’t identify everyone who carries an inherited cancer-risk gene.

Some patients may not meet NHS or insurance criteria for testing, while others may want to understand their risk more fully, even without a strong family history.

At Coyne Medical, we already work with consultants who want to include genetic testing as part of the care they offer their patients.

Our comprehensive 36-gene inherited cancer panel includes BRCA1, BRCA2, PALB2, ATM, CHEK2 and TP53, alongside genes associated with ovarian, pancreatic, bowel and other inherited cancers.

Every patient has a doctor consultation before testing and a scheduled follow-up appointment, whether their result is positive or negative.

We can help patients understand their results, consider appropriate screening and risk-reduction options, and coordinate NHS or private specialist referrals where appropriate.

With the patient’s consent, we can also share results and recommendations with their referring clinician.

We work alongside you, helping you offer your patients more comprehensive preventative care.

What should you do if breast cancer runs in your family?

If your mum, sister, grandmother or another relative has had breast cancer, it’s worth finding out whether there could be an inherited risk.

Start by checking who may qualify for NHS genetic testing.

It can also help to collect information about which relatives have had cancer and how old they were when diagnosed. Our family history of cancer guide explains what to look for.

You can also download our free breast cancer genetics guide, which includes a checklist to help you prepare for a conversation with your GP.

And remember, you don’t need a family history of cancer to carry an inherited cancer-risk gene.

Finding risk earlier creates choices

At Coyne Medical, we believe that understanding your inherited cancer risk can help you make informed decisions about your future health.

Our doctor-led 36-gene inherited cancer panel includes BRCA1, BRCA2 and other genes associated with breast cancer risk.

Every patient has a consultation before testing and a follow-up appointment to explain their results, discuss screening and prevention, and help arrange specialist referrals when appropriate.

Even if genetic testing doesn’t identify an inherited change, we’ll consider your personal and family history and what that may mean for your future health.

---

References

• NICE CG164: Familial breast cancer, referral, risk assessment and prevention
• NICE NG101: Early and locally advanced breast cancer
• NHS England: Eligibility and screening protocols for women at very high risk of breast cancer
• NHS Jewish BRCA Testing Programme
• Viking Genes: NHS Westray and Whalsay BRCA screening project
• Study on updated testing after previously negative BRCA1/2 results
• Manchanda et al.: Population-based genetic testing for cancer susceptibility genes

Medically reviewed by Dr Lucy Hooper MB BS BSc MRCGP MA DRCOG DCH. Review date: 29th October 2026.

This article provides general information and is not a substitute for personalised medical advice. NHS eligibility criteria and testing programmes may change. If you are concerned about your personal or family history, discuss it with your GP or specialist.