BRCA1/2 testing is typically indicated for individuals with which history?

• A. Strong family history suggesting hereditary breast and ovarian cancer syndrome.
• B. Testing is indicated for all cancer patients regardless of family history.
• C. Testing is only for men with breast cancer.
• D. BRCA testing has no clinical utility.

Answer: (A)

BRCA1 and BRCA2 testing is guided by a family history pattern that suggests a hereditary breast-ovarian cancer syndrome. When several relatives are affected with breast or ovarian cancer, cancers occur at a young age, or there is a history of related cancers (for example, male breast cancer or Ashkenazi Jewish ancestry with founder mutations), the likelihood of a pathogenic BRCA variant is high enough to warrant testing. Identifying a pathogenic variant informs not only the patient’s own risk management—such as intensified surveillance, risk-reducing surgeries, or targeted therapies—but also guides testing and preventive strategies for relatives.

Testing all cancer patients regardless of family history is not the standard approach, and testing only men with breast cancer ignores the broader hereditary pattern and the impact on female relatives. BRCA testing does have clinically meaningful utility, so the statement that it has no utility is inaccurate.