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A BRCA variant raises your risk of ovarian cancer substantially — and it does not mean you will develop it. It is a probability, not a prognosis, and it comes with genuinely effective options that most people never get told about.
Everyone has two copies of BRCA1 and two of BRCA2. They are not cancer genes — they are repair genes. Their job is to fix a particular kind of DNA damage that happens in cells all the time, and they do it well. When one inherited copy carries a pathogenic variant, that repair system works less reliably, and over a lifetime the chance of a cell accumulating enough damage to become cancerous rises.
That framing matters, because it explains why a variant is a probability rather than a diagnosis. You are not born with cancer; you are born with a repair system running at reduced capacity. Plenty of carriers never develop any cancer at all — that is especially true for BRCA2, where most women who carry a variant will not develop ovarian cancer in their lifetime.
The inheritance is straightforward and worth understanding: it is autosomal dominant, meaning each child of a carrier has a fifty per cent chance of inheriting the variant, and it passes through fathers as readily as mothers. That last point catches families out constantly. A woman with no ovarian or breast cancer on her mother's side can absolutely carry a BRCA variant inherited through her father.
BRCA1 and BRCA2 fix DNA damage. A variant means that repair works less reliably, not that cancer is present.
Autosomal dominant inheritance. Each child of a carrier has a one-in-two chance of inheriting the variant.
The commonest reason hereditary risk is missed. A quiet maternal side proves nothing about your father's family.
BRCA variants are inherited equally through the paternal line, and this is the single commonest reason hereditary ovarian cancer risk goes unrecognised. A father who carries a BRCA variant has a modest personal cancer risk and may never develop anything, so his side of the family looks unremarkable — while he passes the variant to half his children. Families with few female relatives on the father's side are particularly likely to miss it. When a family history is taken properly, both sides are asked about, and male relatives with breast, pancreatic or prostate cancer count. Source: NCCN Genetic/Familial High-Risk Assessment guidelines.
Approximate lifetime risks from published cohort data. They are estimates for groups, modified by family history and other factors, and no number here predicts what will happen to any individual.
| Ovarian cancer (lifetime) | Breast cancer (lifetime) | |
|---|---|---|
| No known variant (general population) | Roughly 1-2% | Roughly 10-12% |
| BRCA1 pathogenic variant | Roughly 40-45% | Roughly 60-70% |
| BRCA2 pathogenic variant | Roughly 15-20% | Roughly 45-55% |
| After risk-reducing salpingo-oophorectomy | Reduced by roughly 80% | Not the purpose; breast risk managed separately |
*Approximate lifetime estimates drawn from published cohort studies and reflected in NCCN guidance. Individual risk varies with family history, age and other genetic and lifestyle factors, and figures differ between studies. These are for orientation and are not a substitute for personalised genetic counselling.
This is the part that gets lost in the anxiety about the number. A positive result is not simply bad news — it is access to a set of interventions that genuinely work.
Removing the ovaries and fallopian tubes — risk-reducing salpingo-oophorectomy — lowers ovarian cancer risk by around eighty per cent. It is the single most effective intervention available for hereditary ovarian cancer risk, and nothing in surveillance comes close to matching it.
It is typically discussed from around 35 to 40 for BRCA1 carriers and 40 to 45 for BRCA2, after childbearing is complete, because BRCA2-related ovarian cancer tends to occur later. It causes immediate surgical menopause, which is a substantial consideration and needs its own discussion. See risk-reducing surgery.
This is uncomfortable but important. Screening with CA-125 and transvaginal ultrasound has not been shown to reduce ovarian cancer deaths, even in high-risk women. There is no ovarian equivalent of mammography or cervical screening, and pretending otherwise does harm.
Some high-risk women do choose surveillance, particularly while deferring surgery for fertility reasons, and it is offered in that context with honest counselling about its limitations. But it is a stopgap rather than protection, and understanding that is what makes the surgical conversation an informed one. See high-risk surveillance.
BRCA variants raise breast cancer risk more than ovarian cancer risk in absolute terms, and here the tools are better. Enhanced surveillance with annual MRI alongside mammography from a younger age detects breast cancer early and works, unlike ovarian screening.
Risk-reducing mastectomy is an option some women choose, and risk-reducing medication is discussed in some situations. The breast pathway runs alongside the ovarian one rather than instead of it. See the BRCA breast-ovarian link.
BRCA status is not only about prevention — it changes treatment. Ovarian cancers arising in BRCA carriers have a defective DNA-repair pathway, which makes them more sensitive to platinum-based chemotherapy and responsive to a class of drugs known as PARP inhibitors, used as maintenance therapy.
This is why testing is now offered to essentially all women diagnosed with epithelial ovarian cancer regardless of family history: the result guides treatment for the patient, not just risk assessment for her relatives. CION delivers this maintenance treatment in-house.
A confirmed variant in you means each of your siblings and children has a fifty per cent chance of carrying it, and testing them for that specific variant is straightforward and inexpensive once it has been identified. This is called cascade testing.
Many carriers find this the hardest part — telling family, and managing how differently people respond. Genetic counselling includes practical support with those conversations, including written information you can pass on. See cascade testing.
For carriers planning a family, there are options worth knowing about early rather than late. Prenatal testing and pre-implantation genetic testing during IVF can both be discussed, and views on whether to use them vary enormously and legitimately between individuals.
The reason to raise it early is timing: risk-reducing surgery is usually recommended after childbearing is complete, so family planning and risk management are the same conversation rather than separate ones. See fertility and ovarian health.
You do not need every one of these. Any single one is a reasonable reason to seek genetic counselling.
Ovarian cancer in a close relative at any age is a recognised indication, regardless of how old she was at diagnosis.
Testing is now offered to essentially all women with epithelial ovarian cancer, because the result guides your own treatment.
Especially a close relative, and particularly if more than one relative is affected or one had cancer in both breasts.
In the same person, or in relatives on the same side of the family. This pattern is the classic signature.
Uncommon and strongly associated with BRCA2. A single case is enough to warrant a genetics referral.
If someone in your family carries an identified variant, testing you for that specific change is quick, cheap and definitive.
Ashkenazi Jewish ancestry, and certain other founder populations, carry a higher prevalence of specific BRCA variants — worth mentioning if it applies to your family.
A BRCA test is easy to order and hard to interpret. Counselling beforehand covers what each possible result would mean for you and for your relatives — and CION provides it in-house.
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No referral needed and no cost for the first consultation. Genetic counselling and BRCA testing are delivered in-house at CION.
The test itself is the easy part. The counselling either side of it is what makes the result useful.
A detailed three-generation family history from both sides, an explanation of what each possible result would mean, and a discussion of the implications for you and your relatives. This step is not a formality — it is what turns a laboratory result into a decision you can actually act on, and it happens before any blood is taken.
A blood or saliva sample. Increasingly this is a multi-gene panel rather than BRCA1 and BRCA2 alone, because several other genes — including the Lynch syndrome genes and others such as RAD51C, RAD51D and BRIP1 — also raise ovarian cancer risk and are worth testing in the same pass. Results typically take a few weeks.
A pathogenic variant is a definite finding with clear implications. No variant found is reassuring but does not eliminate risk, particularly with a strong family history — it may simply mean the responsible gene has not been identified. A variant of uncertain significance is a change whose meaning is not yet known, and it is managed as though it had not been found, on family history alone.
Where a variant is found, this covers surveillance, the timing of risk-reducing surgery, breast risk management, and reproductive considerations. The plan is individual — a 32-year-old hoping to have children and a 48-year-old with a completed family are in very different positions with the same result.
Once a specific variant is identified in the family, testing relatives for that exact change is fast, inexpensive and gives a clear yes or no. Genetic counselling includes support with informing family members, which many people find the most difficult part of the whole process.
Carrying a variant is a lifelong piece of information, and the guidance around it evolves. Staying connected to a genetics service means surveillance and management can be updated as evidence changes, rather than acting on advice given years earlier.
This is one of the areas where CION delivers the service itself rather than coordinating it. BRCA and HRD testing and genetic counselling are in-house, which matters practically: the counselling before the test, the test, the explanation of the result and the plan that follows all happen with the same team rather than across three referrals and several months.
Your first consultation is free and runs to about 45 minutes. If you are here because of a family history, bring what you know — who had what cancer, at what age, and on which side of the family. It does not need to be complete or documented; a rough picture is enough to establish whether formal counselling is warranted, and we can help fill in the gaps.
If you already have a result, the useful conversation is usually about what to do with it rather than what it says. Where a woman with a variant does develop ovarian cancer, CION delivers medical oncology in-house — chemotherapy and maintenance therapy including PARP-inhibitor-class treatment across 35+ centres. Risk-reducing surgery and any debulking procedure is coordinated with specialist gynaecologic-oncology partner centres and may be billed there.
Counselling, testing and the plan that follows delivered by one team rather than spread across referrals.
Free and unhurried. Long enough to take a proper family history from both sides.
Where cancer does develop, chemotherapy and PARP-inhibitor-class maintenance are delivered at CION across 35+ centres.
Risk-reducing salpingo-oophorectomy and any debulking is done with specialist partner centres and may be billed there. We say so upfront.
The clinical pathway after a positive result is well defined. The emotional one is not, and it deserves saying out loud. Women describe a strange in-between state — not a patient, not entirely well, carrying information about a future that may never arrive. The word previvor exists precisely because no existing category fitted.
The decisions are genuinely difficult and there is often no clearly correct answer. Risk-reducing surgery works, and it brings surgical menopause forward by years, with real consequences for bone health, cardiovascular health and quality of life that have to be weighed rather than dismissed. Deferring it to complete a family is a legitimate choice with a cost attached. So is having it early.
Telling relatives is frequently the hardest part. Some want to know immediately, some do not want to know at all, and both responses are legitimate. It is not your responsibility to make anyone test. What you can do is make sure the information is available to them, and genetic counselling includes practical help with that — including written material you can pass on without having to explain it yourself. See living as a previvor.
Timing risk-reducing surgery against fertility and menopause is a genuine trade-off, not a question with a hidden correct response.
Bone and cardiovascular health and quality of life all need weighing, and managing them is part of the plan rather than an afterthought.
Your job is making the information available. How each person responds to it is theirs.
Genetic counselling covers the conversations as well as the biology, including written material to pass to family.
No. A BRCA variant raises risk substantially but does not make cancer certain, and this distinction matters enormously. Published estimates put lifetime ovarian cancer risk at roughly 40 to 45 per cent for BRCA1 carriers and roughly 15 to 20 per cent for BRCA2 — meaning most BRCA2 carriers will never develop ovarian cancer at all, and a majority of BRCA1 carriers will not either. These are group estimates that vary with family history, age and other factors. What a variant does give you is access to interventions that genuinely lower the risk further.
Both raise risk, but BRCA1 raises ovarian cancer risk considerably more — roughly 40 to 45 per cent lifetime risk compared with roughly 15 to 20 per cent for BRCA2. The timing differs too: BRCA1-related ovarian cancer tends to occur earlier, which is why risk-reducing surgery is generally discussed from around 35 to 40 for BRCA1 carriers and 40 to 45 for BRCA2. Both also raise breast cancer risk substantially, with BRCA1 again somewhat higher. Which gene is involved genuinely changes the recommended timing of surgery, so it is not a technicality.
Possibly, because ovarian cancer is not the only signal. Breast cancer under 50 in close relatives, breast cancer in more than one relative, cancer in both breasts in one person, male breast cancer, and pancreatic or prostate cancer in the family can all point to a BRCA variant. Crucially, BRCA passes through fathers as readily as mothers, so a quiet maternal side proves nothing — and families with few female relatives on the father's side very often miss it. Ashkenazi Jewish ancestry also raises the prevalence of specific variants. Any of these is worth a genetics discussion.
Not one that has been shown to save lives, and it is important to be honest about this. Surveillance with CA-125 and transvaginal ultrasound has not been demonstrated to reduce ovarian cancer deaths, even in high-risk women, and there is no ovarian equivalent of mammography or cervical screening. Some high-risk women do choose surveillance, particularly while deferring risk-reducing surgery for fertility reasons, and it is offered in that context with clear counselling about its limitations. It is a stopgap rather than protection — which is precisely why the surgical conversation matters so much.
Considerably. Removing the ovaries and fallopian tubes lowers ovarian cancer risk by around eighty per cent, making it by far the most effective intervention available for hereditary ovarian cancer risk. The reduction is not one hundred per cent because a small risk of primary peritoneal cancer remains — the peritoneal lining shares an origin with the ovarian surface and cannot be removed. Timing is individual, generally from around 35 to 40 for BRCA1 carriers and 40 to 45 for BRCA2, after childbearing, and the resulting surgical menopause needs its own careful discussion.
It means a change was found in the gene but there is not yet enough evidence to say whether it affects how the gene works. It is genuinely uncertain rather than a hedged positive, and it is managed as though it had not been found — decisions are based on your family history alone, not on the variant. These reclassifications happen over time as more data accumulates, and most variants of uncertain significance are eventually reclassified as benign. Staying connected to a genetics service means you would be informed if yours were reclassified.
You are not obliged to, and many people find this the hardest part of the whole process. What is worth weighing is that a confirmed variant in you means each sibling and each child has a fifty per cent chance of carrying it, and that testing them for that specific known change is quick, inexpensive and definitive. You cannot make anyone test, and some relatives will choose not to know — which is a legitimate choice. What you can do is make the information available. Genetic counselling includes practical help with those conversations, including written material you can simply pass on.
Yes — genetic counselling and BRCA and HRD testing are delivered in-house at CION, which means the counselling before the test, the test itself, and the explanation and plan afterwards all happen with the same team rather than across several referrals. The first consultation is free and runs to about 45 minutes. CION also delivers medical oncology in-house, including chemotherapy and PARP-inhibitor-class maintenance treatment, across more than 35 centres. Risk-reducing salpingo-oophorectomy and any debulking surgery is coordinated with specialist gynaecologic-oncology partner centres and may be billed there.