BRCA risk assessment: who needs it and when

When it starts, when it can stop

Starts: The USPSTF sets no starting age. It applies when a personal or family history, or ancestry, is linked to BRCA1/2 gene changes. (USPSTF, 2019)
Can stop: It is a one-time assessment, with counseling and testing only if it is positive. (USPSTF, 2019)

Who it is for

Women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or an ancestry linked to BRCA1/2 gene changes. (USPSTF, 2019)

In My Screening Plan this shows up when you tick: Personal or family history of breast, ovarian, tubal or peritoneal cancer.

Test and how often

A brief familial risk assessment tool in primary care. (USPSTF, 2019)
If that is positive, genetic counseling, and genetic testing if the counseling supports it. (USPSTF, 2019)

Who gets a risk check, counseling and testing

BRCA-related cancer risk: the three steps in the USPSTF 2019 recommendation
Step	Who	What happens
1. Family history check	Women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or an ancestry linked to BRCA1/2 changes	A brief risk assessment tool in primary care (grade B)
2. Genetic counseling	Women with a positive result on the risk tool	A trained professional reviews the family history in detail and discusses testing
3. Genetic testing	Women for whom counseling shows testing is indicated	A test for harmful BRCA1/2 changes
None	Women whose history and ancestry are not linked to BRCA1/2 changes	No routine risk check, counseling or testing (grade D)

The recommendation sets no age. What matters is personal and family history and ancestry. The family history covers close relatives (parents and siblings) and more distant ones (aunts, uncles, grandparents and cousins), with their age at diagnosis. (USPSTF, 2019)

The USPSTF found no one risk tool better than the others. Tools it reviewed include the Ontario Family History Assessment Tool, the Manchester Scoring System and the Pedigree Assessment Tool. (USPSTF, 2019)

The National Cancer Institute says anyone worried about an inherited BRCA change can talk with a health care provider or genetic counselor about whether testing is right for them, and that expert groups focus testing on people more likely to carry a harmful change. (NCI)

For women at increased risk of breast cancer, medicines that lower the risk are another topic to discuss. Read more: medicines to lower breast cancer risk.

Where the USPSTF draws the line

Grade C means a small net benefit, so it is offered to some people; D means do not screen; I means the evidence is not enough to decide. (USPSTF grade definitions)

Grade D: no routine risk assessment, counseling or testing for women whose history and ancestry are not linked to BRCA1/2 changes. (USPSTF, 2019)

The USPSTF lists an update to this topic as in progress. Until it is final, the 2019 statement above applies. (USPSTF, 2019)

Questions people ask

Should everyone get a BRCA test?

No. The USPSTF recommends against routine risk assessment, counseling or testing for women whose personal or family history or ancestry is not linked to BRCA1/2 changes (grade D). (USPSTF, 2019)

At what age should I have a BRCA risk assessment?

The USPSTF sets no age. The check is for women of any adult age whose own or family history of breast, ovarian, tubal or peritoneal cancer, or whose ancestry, points to a possible BRCA1/2 change. (USPSTF, 2019)

What happens if the risk tool is positive?

The USPSTF says you should be offered genetic counseling with a trained professional, and genetic testing if the counseling shows it is indicated. (USPSTF, 2019)

I am worried about my family history. What should I do?

Talk with your doctor or a genetic counselor. The National Cancer Institute says anyone concerned about an inherited BRCA change can discuss whether testing is right for them. (NCI)

Is the BRCA recommendation being updated?

An update is in progress. On our review the USPSTF update page was last updated April 5, 2024 and showed no draft recommendation yet, so the 2019 statement still applies. (USPSTF, 2019)

Source

U.S. Preventive Services Task Force, "BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing", final recommendation released August 20, 2019. Read it on uspreventiveservicestaskforce.org. Checked against the live page on 2026-10-28.