BRCA gene testing is available through genetic counselors, cancer centers, and your primary care doctor’s office. The most common path is a referral to a genetic counselor, who will help determine which tests you need and order them through an accredited laboratory. Most patients pay between $0 and $250 out of pocket.
Genetic Counselors and Cancer Centers
Genetic counselors who perform BRCA testing typically work within the breast health or oncology departments of academic medical centers and cancer centers. These specialists do more than just order a test. They review your personal and family history, assess whether testing makes sense for your situation, and help you understand what different results would mean before you get them. This pre-test counseling is the standard first step.
To find a genetic counselor near you, there are several searchable directories. The National Society of Genetic Counselors (NSGC) maintains a directory you can filter by ZIP code and specialty. The American Board of Genetic Counseling (ABGC) offers a similar directory of certified counselors worldwide. You can also ask your primary care doctor for a referral or call your insurance company to find an in-network provider. If you’re near a major medical center, contacting their cancer risk evaluation program directly is another option.
Your Primary Care Doctor Can Start the Process
You don’t necessarily need to find a genetic counselor on your own. Your primary care physician or OB-GYN can evaluate your family history and refer you for counseling and testing. In some cases, these doctors can order BRCA testing themselves, though a genetic counselor is better equipped to guide you through the nuances of choosing the right panel and interpreting results. If you already know a specific mutation runs in your family, the process is even more straightforward since the lab can test for that single variant.
Why At-Home DNA Kits Fall Short
Consumer DNA tests like 23andMe do screen for a handful of BRCA mutations, but they are not a substitute for clinical testing. These kits check only three specific mutations most common in people of Ashkenazi Jewish descent. A large retrospective study found that direct-to-consumer testing misses more than 90% of harmful BRCA1 and BRCA2 mutations in people without Ashkenazi Jewish ancestry. Even among Ashkenazi Jewish individuals, about 10% of mutations were missed.
The accuracy problems go both ways. For mutations outside those three common variants, the false-positive rate in at-home tests was as high as 89.7% for BRCA mutations and 69% for other cancer risk genes. That means a positive result from a consumer test has a high chance of being wrong. Clinical laboratories, by contrast, are required to meet strict federal certification standards and test comprehensively across more than 2,400 known BRCA variants. If you’ve taken a consumer test and received any result, positive or negative, it should not be used to make medical decisions without confirmatory clinical testing.
What the Test Involves
The test itself is simple. A healthcare provider collects either a blood sample or a saliva sample, which is sent to an accredited genetics laboratory for analysis. There’s no special preparation required. Results typically take a few weeks, after which you’ll meet with your genetic counselor again to go over the findings and discuss what they mean for your health management and your family members.
Cost and Insurance Coverage
Under the Affordable Care Act, private health plans are required to cover genetic counseling and BRCA testing with no out-of-pocket cost for women who meet risk criteria based on their personal or family history. Medicare also has coverage pathways. In practice, most patients end up paying somewhere between $0 and $250.
If you don’t have insurance or don’t meet standard coverage criteria, many genetic testing laboratories offer a self-pay rate of around $250. Financial assistance programs also exist. The Hereditary Cancer Foundation, for example, reviews applications on a case-by-case basis and pays the laboratory directly on behalf of approved applicants. Priority goes to people who meet national guidelines for testing, have a known family mutation, or demonstrate financial need. Applications are free, and decisions typically come within 14 days.
Who Should Consider Testing
BRCA testing is most valuable for people with specific risk factors: a strong family history of breast or ovarian cancer, a family member already known to carry a BRCA mutation, breast cancer diagnosed before age 50, ovarian cancer at any age, male breast cancer, or multiple cancers in the same person. Ashkenazi Jewish heritage also raises the likelihood of carrying a BRCA mutation. National guidelines use these factors to determine who benefits most from testing, and meeting them is typically what triggers insurance coverage.
That said, the landscape has shifted toward broader testing. If you’re unsure whether your history qualifies, a genetic counselor can assess your specific situation and help you decide whether testing is the right next step.