BRCA testing in London: who qualifies, cost and what results mean

Perhaps two women on one side of your family have had breast cancer, or a cousin has just told everyone she carries a BRCA mutation. Suddenly the family tree looks heavier than it did, and you want to know where you stand.

A BRCA test can help with that. You may well qualify for free testing on the NHS, and if you don't, or would rather not wait, you can have it privately. Here, testing begins with a mini consultation and pre-test genetic counselling, and blood is taken only if testing is judged suitable and you still want to go ahead. The service is led by Dr Hikmat Naoum, Consultant Gynaecologist (GMC 3047637), at 117a Harley Street.

If you already know you would like to talk it through, send an enquiry from our BRCA testing page or call 0207 499 1991. The full BRCA1 and BRCA2 panel is £662, including the £100 referral fee and a mini consultation.

What does a BRCA test actually tell you?

BRCA1 and BRCA2 are two genes that can carry inherited changes. The NHS explains that faults in these genes raise the chance of certain cancers that run in families, including breast, ovarian and prostate cancer. Our sister clinic has more on BRCA gene testing if you would like the detail.

The size of that raised chance is worth knowing. A large study of nearly 10,000 carriers, highlighted by Cancer Research UK, put the numbers in plain terms. By age 80, the risk of breast cancer was about 72% for BRCA1 and 69% for BRCA2. The risk of ovarian cancer by 80 was about 44% for BRCA1 and 17% for BRCA2.

The thing most people find useful to hear early is this: a gene change tells you about risk. It doesn't mean you will develop cancer, and it says nothing about whether you have cancer today. It is information about the future, which is exactly why it deserves a proper conversation first.

Can you get BRCA testing free on the NHS?

Often, yes. The NHS offers genetic testing for cancer risk when:

• a close relative, such as a parent, sibling or child, has been told they carry a faulty gene that raises cancer risk;
• several people in your family have had certain types of cancer, such as breast, ovarian, prostate or pancreatic cancer;
• you have a Jewish background.

Behind that, NICE guideline CG164 uses a threshold: testing is offered when your combined chance of carrying a BRCA1, BRCA2 or TP53 change is estimated at 10% or more. Your GP or an NHS genetics service works that out from your family tree.

Jewish ancestry has its own NHS programme because BRCA changes are more common. About 1 in 40 Ashkenazi Jewish people and about 1 in 140 Sephardi Jewish people carry one, against about 1 in 250 people in the wider UK population. NHS England ran a free Jewish BRCA testing programme for anyone in England aged 18 or over with at least one Jewish grandparent, using a saliva kit sent by post. The pilot has now closed to new registrations, and NHS England expects a permanent service to be in place in 2027. In the meantime, Jewish ancestry still counts when your GP considers a referral.

If you meet NHS criteria, NHS testing is free, so it is worth asking your GP first. If you fall outside the criteria, or would rather have the test now, you can enquire here. Our testing sits alongside NHS genetics services rather than replacing them.

Why does counselling come before the blood test?

A result can affect you and, sometimes, your relatives. It helps to have thought that through before you hear it.

In the mini consultation and counselling, the clinician asks why you have come and who in the family has had breast or ovarian cancer, and at what age. They check whether a mutation is already known and whether your own history is relevant. This is also where the limits of the test are explained. If testing turns out not to suit you, you will hear that before any laboratory form is completed.

NHS genetics services work in the same order, with a genetic counsellor or specialist first and a blood test only if that review suggests it may help. Private testing here follows that order too. If testing goes ahead, a blood sample is taken at the clinic for BRCA1 and BRCA2 analysis. Laboratory timing is confirmed when we handle your enquiry, and the result is reviewed with you at the results consultation.

Who might want to discuss BRCA testing?

Most people get in touch because of family history, not because they feel unwell. Good reasons to talk it through include:

• several relatives with breast or ovarian cancer
• breast cancer diagnosed at a young age in the family
• a known BRCA mutation in the family
• Jewish ancestry, especially with breast, ovarian or prostate cancer in the family
• a personal history that your clinician identifies as relevant

These are starting points for a conversation rather than a checklist to score yourself against. Men can enquire too: BRCA changes pass through sons as well as daughters, and the test being listed under women's health doesn't change that.

Before the first conversation, write the family history down. Who had which cancer, and roughly how old they were when diagnosed, tells the clinician far more than a feeling that there is a lot of cancer in the family. If a relative has a letter naming a BRCA mutation, ask whether you can bring a copy, and bring your medicine list. If your GP has already referred you, or you are under NHS genetics, mention it at the start.

What can a result say? Positive, negative or uncertain

Results come in three kinds, and each is explained in the room with your written report.

The three kinds of BRCA result

That last row matters more than people expect. A negative result doesn't remove a familial risk that comes from other genes or from shared factors, and it doesn't test your relatives. Your clinician will tell you which kind of negative you have.

If the result is positive, what are the options?

A positive result gives you choices rather than a fixed plan. The NHS describes three broad kinds of help: regular checks that can find cancer before symptoms, treatment that lowers your risk, and support with lifestyle changes. For BRCA carriers that can mean:

• Extra breast screening. NICE CG164 recommends yearly breast MRI for carriers aged 30 to 49, with mammograms added from 40 and continued through later life.
• Risk-reducing surgery, such as removing breast tissue or the ovaries and fallopian tubes, usually discussed once a family is complete and never rushed.
• Risk-reducing medicines for some women, discussed with a specialist.
• Testing for relatives. Each child of a carrier has a 1 in 2 chance of inheriting the change. Your result can help brothers, sisters and children decide about their own testing.

Further specialist referral may be needed after the mini consultation or after a result, and any extra fee is explained before a referral is arranged. On its own a result won't decide which medicines to start or which operations to have, and you will still want screening.

What if you have found a lump, or have other symptoms?

A new breast lump needs a doctor to examine it, and that is a more useful first step than a gene test. NHS advice is to see a GP if you notice a lump in the breast or armpit. The same goes for a nipple turning inwards, dimpled skin or bloodstained nipple discharge. Most lumps are not cancer. You can see your GP, or call us about a breast lump assessment.

Which appointment fits your question

What is included in the £662?

The BRCA1 and BRCA2 full panel is £662. That includes the £100 referral fee and a mini consultation, and the package covers counselling, gene analysis, a results consultation and a written report. It is a genetic test, separate from our breast screening package, and it sits alongside NHS screening programmes rather than standing in for them.

Medical Express Clinic has practised at 117a Harley Street since 1984 and is CQC-registered. If you are weighing up other checks, our guides on seeing a GP or a gynaecologist first, mammogram or breast ultrasound and what a full-body MRI can show may help.