If you’re newly diagnosed with high grade serous epithelial ovarian cancer, you should be offered BRCA and HRD testing. If you don’t have high grade serous ovarian cancer it is still worthwhile having a conversation with your team, as sometimes testing of any non-mucinous ovarian cancer is possible depending on other factors such as your family history of cancer.

It’s important to talk to your team about BRCA and HRD testing soon after diagnosis, as the results can affect your treatment options as well as your family’s risks.

This is because the access to a type of drug called PARP (poly ADP-ribose polymerase) inhibitors depends on your HRD and BRCA test results. PARP inhibitors must be started within eight weeks of your last cycle of chemotherapy, so testing needs to happen early enough for the results to come back in time.

You will be offered either a blood test to test for a heritable BRCA gene change (called a “germline” mutation) or a test of your tumour (for a “somatic” or tumour mutation). HRD testing is done only on your tumour. If you only have a tumour test and a BRCA gene change is found, you would need a blood test to confirm whether this gene change is only in your tumour, or in all your cells in your body. These tests could also happen both at the same time- your team will talk to you about the most appropriate approach for you.

If your testing finds a BRCA gene change in either your blood or tumour test, or that your tumour is HRD positive, your team will discuss with you whether olaparib would be a suitable treatment for you and, if so, help you to decide whether you want to take it. If these tests are both negative, you won’t be eligible for olaparib, but depending on your diagnosis and medical history, you may be able to take a different PARP inhibitor either through your treating team or as part of a clinical trial.

PARP availability has been changing in recent years, so it’s important to ask your team for the most up to date information. You can find out more about PARP inhibitors and other targeted therapies here.

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What’s the risk for my family?

If your blood test shows a BRCA gene change, then this means that the change is hereditary and other members of your family may be affected. The chances that each of your first-degree relatives (parents, children, brothers/sisters) carry the same gene change is 1 in 2 (50%). Your team can help advise you on how to talk to them about this and how they can find out more about their risk. (Note that testing under 18s is not usually possible.)

If the BRCA gene change is only found in the tumour and not in your blood test, then this means that the change is not found in all the cells in your body. This gene change happened spontaneously, or by chance. It was not inherited, and you cannot pass it on to children. If your blood test comes back negative for changes to the BRCA gene, then no extra screening for your family is needed. Their risk of ovarian cancer is slightly increased due to unknown factors that we cannot test for. However, the risk is increased if more family members have develop ovarian or breast cancer.

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Watch Genetic testing, an Ovacome webinar with Dr Terri McVeigh, Consultant Clinical Geneticist specialising in cancer genetics

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You can find more information about BRCA gene changes, their risks and testing for them at:

A beginner's guide to BRCA1 and BRCA2

Predictive genetic tests for cancer risk genes - NHS

If you would like to share your experiences of genetic testing, please comment on this post. If you would like information or support, please contact our Support Line on 0800 008 7054 or email [email protected].