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Talking to Your Family About Inherited Breast Cancer Risk
Reviewed by Elizabeth Arena, MD, FACS. Last reviewed: October 25, 2026.
If you carry a BRCA mutation, your children and your brothers and sisters may carry it too. Adult relatives can be tested for that one mutation with a blood or saliva sample; this is called single-site testing. Dr. Elizabeth Arena, a breast surgical oncologist in Los Angeles, sees women who carry a BRCA mutation and their relatives, orders their yearly breast MRI and mammograms and performs risk-reducing (preventive) mastectomy.
How to tell your family, and what they should do next
Tell your parents, brothers, sisters and adult children first, in person or by phone. Then send each of them the gene and variant name in writing, so their doctor or genetic counselor can order a single-site test. [2] [3]
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Check what your report found
Share the result with relatives only if the lab classified the change as pathogenic or likely pathogenic, meaning it raises cancer risk. A variant of uncertain significance (VUS) is a change the lab cannot classify yet; most are later found to be harmless. [2]
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Find the variant name
Your report lists the gene, BRCA1 or BRCA2, followed by the exact change in a form like c.5946delT. A relative's lab needs both to run the right test. [3]
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Send the variant name in writing
In a study of 561 parents, brothers, sisters and children of women who had BRCA testing, 22% did not remember being told the result. Of those who did remember, 18% remembered it incorrectly. [1] Copy the gene and variant name exactly as your report shows them into a letter, email or text. A genetic counselor can write a family letter for this; ask the counselor or doctor who gave you your result. [6]
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Tell them where to be tested
A relative can see a genetic counselor or their own doctor, who orders the single-site test. [3] [4] In Los Angeles, Dr. Arena takes the sample at her office; see genetic testing with Dr. Arena.
When should you tell your children?
BRCA testing is not recommended for anyone under 18. Children are very unlikely to develop a BRCA-related cancer and no screening, medication or surgery is recommended for them. [2] A daughter who carries the mutation would usually start yearly breast MRI between 25 and 30, so she needs to know before she turns 25. [5] Sons need the same information, since they can carry the mutation and pass it to their own children. [1]
With a younger child, answer the questions they ask in words that fit their age. Children ask more detailed questions as they grow, so plan to explain the mutation again before they turn 18 and can choose to be tested. [3]
My sister or mother tested positive for BRCA. Do I have it?
If your parent, brother or sister carries a BRCA mutation, you have a 1 in 2 chance of carrying it too. [1] A single-site test shows whether you do; your doctor or a genetic counselor orders it using the variant name on your relative's report.
- A sister or brother tested positive: each child of a carrier inherits the mutation or not, separately from the others, so one sister can carry it while another does not. [1]
- Your mother tested negative for the family's mutation: you did not inherit it from her. [2] You can still carry it if your father does.
What does your relative's test result mean?
| Your relative's result | What it means | Screening and surgery to discuss |
|---|---|---|
| Positive for your family's mutation | They carry the same mutation. Women have a higher risk of breast and ovarian cancer; men, of breast and prostate cancer [2] | Women usually start yearly breast MRI between 25 and 30 and add a yearly mammogram at 30 [5]; a gynecologic surgeon discusses removing their ovaries and fallopian tubes. Men ask their doctor about yearly mammograms and prostate cancer screening [2] |
| Negative for your family's mutation | They did not inherit it and cannot pass it to their children [2] | Their doctor may still recommend earlier or extra screening if other relatives have had breast cancer [2] |
| Not tested yet | 1 in 2 if they are your child, brother or sister | Women have the yearly MRI and mammogram recommended for a carrier until their result comes back [7] |
Relatives who carry the mutation, or who have not been tested yet, can see Dr. Arena in her high-risk breast program.
What if a relative does not want to be tested?
Send the gene and variant name once by email or text with a link to this article, then let them decide when to be tested. A relative who decides later can give that message to their doctor or a genetic counselor, who orders the test.
Can relatives outside Los Angeles be tested?
Yes. A relative can be tested near home in any of these ways:
- Through a genetic counselor: the National Society of Genetic Counselors keeps a directory at findageneticcounselor.nsgc.org.
- Through their own doctor: a primary care doctor or gynecologist can refer them for genetic counseling and testing. [4]
- With Dr. Arena by video: virtual consultations may be available to relatives in states where she is licensed.
Why see Dr. Arena about inherited breast cancer risk in Los Angeles?
- Double board certification: Dr. Arena is double board-certified in general surgery and complex general surgical oncology and a Fellow of the American College of Surgeons.
- Genetic testing at her office: she takes the sample at the visit, for you or for a relative testing for your family's mutation.
- Review of your MRI and mammogram reports: she checks each radiologist's report against your previous images.
- Risk-reducing surgery: she performs nipple-sparing mastectomy and aesthetic flat closure (mastectomy without reconstruction). If you choose reconstruction, a plastic surgeon performs it in the same operation or later.
For a relative who tests positive, Dr. Arena will either have regular consultations with you where she monitors your situation or perform a risk-reducing mastectomy, which lowers the risk of breast cancer by at least 95%.
Frequently asked questions
Can you have a BRCA mutation if neither parent has it?
Rarely. A BRCA mutation that neither parent carries, called a de novo mutation, is uncommon; almost every BRCA mutation is inherited from a parent. [1]
Should relatives see a genetic counselor before they are tested?
Yes. The US Preventive Services Task Force recommends genetic counseling before BRCA testing, so a relative knows what a positive or negative result would mean for them before the sample is taken. [4]
Can a genetic test result affect your insurance?
A federal law, the Genetic Information Nondiscrimination Act (GINA), stops health insurers from using genetic information to decide coverage or premiums and stops employers from using it in hiring, firing or pay. GINA does not cover life, disability or long-term care insurance. [8]
Does insurance pay for a relative's genetic counseling and testing?
Genetic counseling about BRCA testing for women at higher risk is one of the preventive services health plans generally cover at no cost when a doctor or counselor in the plan's network provides it. [9] The US Preventive Services Task Force includes women whose relative carries a known harmful BRCA mutation among those who should be offered counseling, followed by testing if the counselor recommends it. [4] Whether a plan pays for the test itself varies, so a relative should check with their insurer. Dr. Arena's practice accepts most major PPO plans with out-of-network benefits, plus cash pay and self-pay.
Sources
- National Cancer Institute. Genetics of Breast and Gynecologic Cancers (PDQ®), Health Professional Version. Updated March 6, 2025. https://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq
- National Cancer Institute. BRCA Gene Changes: Cancer Risk and Genetic Testing. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet
- Centers for Disease Control and Prevention. Talking to Family About Your BRCA Gene Mutation. Updated September 30, 2026. https://www.cdc.gov/breast-ovarian-cancer-hereditary/conversation-tips/index.html
- US Preventive Services Task Force. BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing. August 20, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing
- Monticciolo DL, Newell MS, Moy L, et al. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. Journal of the American College of Radiology. 2023. https://doi.org/10.1016/j.jacr.2023.04.002
- Living Beyond Breast Cancer. How and when to share your genetic test results with family. December 22, 2024. https://www.lbbc.org/about-breast-cancer/testing/genetic/sharing
- American Cancer Society. American Cancer Society Recommendations for the Early Detection of Breast Cancer. Last revised July 23, 2026. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
- National Human Genome Research Institute. Genetic Discrimination. https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination
- HealthCare.gov. Preventive care benefits for women. https://www.healthcare.gov/preventive-care-women/
- National Cancer Institute. Surgery to Reduce the Risk of Breast Cancer. https://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet
Speak with Dr Arena about your next step
Whether you have a new diagnosis, want another opinion, are weighing surgical options or need a concerning finding assessed, the first step is a consultation focused on your specific situation.