BRCA decision: counselling first, not a same-day blood test

You have a family tree that suddenly looks heavy, a relative with a known BRCA mutation, or an advert that makes BRCA1 and BRCA2 look like a walk-in panel. Those are not the same decision. Sending a gene test because a website offered a tube is how people sit with a result they were not ready to hear, or wait on a genetics enquiry while a new breast lump has not been examined.

The BRCA decision at Medical Express Clinic is whether to send an enquiry for BRCA1 and BRCA2 testing that starts with a mini consultation and pre-test genetic counselling, before anyone completes a laboratory form. It is not a same-day walk-in blood test. Dr Hikmat Naoum, Consultant Gynaecologist, GMC 3047637, leads the service at 117a Harley Street. Suitability is reviewed before testing.

This is not a walk-in blood test

You cannot treat this as a same-day walk-in blood test. A BRCA test looks for inherited changes in BRCA1 and BRCA2, with BRCA gene testing on the sister page. NHS pages on genetic tests for cancer risk explain that faults in those genes can raise the chance of certain cancers that run in families, including breast, ovarian and prostate cancer, and that a gene change does not mean you will definitely develop cancer. That is risk information rather than a scan of a lump.

The laboratory form is the last part of a private enquiry here, not the first. Blood is taken only if, after the mini consultation and pre-test genetic counselling, testing is judged suitable and you still want to go ahead. The counselling exists because a result can affect you and, sometimes, relatives.

What happens before any laboratory form

You start with an enquiry, not a walk-in slot. The included mini consultation and pre-test genetic counselling sit before the laboratory form. That conversation is where the clinician looks at why you have come, who in the family has had breast or ovarian cancer, at what age, whether a mutation is already known, and whether your own history is relevant. It is also where the limits of the test are explained.

NHS genetic-testing pages describe the same order in public care: you usually see a genetic counsellor or specialist first, and a blood test is offered only if that review suggests it may help. Private testing at this clinic is still built around that order.

If testing proceeds, a blood sample is taken at the clinic for BRCA1 and BRCA2 analysis. The package then includes gene analysis, a results consultation and a written report. Laboratory timing is confirmed when the clinic handles your enquiry. The result is reviewed with you at the results consultation.

Who may reasonably discuss testing

Reasons to discuss BRCA testing here 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, and a personal history that your clinician identifies as relevant. Many people enquire because of family history, not because they feel unwell today. Those are starting points for a conversation, not a self-completed eligibility quiz.

Men can enquire. BRCA gene changes can sit in families through sons as well as daughters. A man with a relevant family history, or with a personal history a clinician thinks matters, is not turned away because the test is listed under women's health. Suitability is still reviewed before testing. An enquiry is not a promise that a laboratory form will be signed.

Bring names, cancers, ages at diagnosis, and any letter that already names a BRCA mutation. If nobody in the family has been tested, say so. If someone has, bring the paperwork. The clinician cannot review a family tree that exists only as a feeling that there is a lot of cancer.

What NICE familial breast cancer guidance is for

NICE publishes public guidance on familial breast cancer. It covers how a family history of breast, ovarian or a related cancer is classified, and it treats genetic testing as something discussed after information and counselling, not as a form completed in isolation. It also covers surveillance and early detection where family history sits in a higher-risk group.

UK practice already treats BRCA testing as a specialist conversation, not as a walk-in panel. A Harley Street enquiry does not rewrite that, and it does not replace NHS genetics services. If a GP has already referred you, or a relative has already had NHS testing, say so at the start. If you meet NHS criteria, NHS genetic testing is free, so ask your GP about referral first. Risk is individual, and it is reviewed with your own result and history.

When this enquiry is the wrong door

A new breast lump needs clinical assessment, not a genetic-testing enquiry.

Which question belongs with a BRCA enquiry.

NHS advice is to see a GP if you notice a lump in the breast or armpit, or other unusual breast changes such as a nipple turning inwards, dimpled skin or bloodstained nipple discharge. Most lumps are not cancer, and you cannot tell which is which from a family tree. A BRCA result does not examine the lump you found this week.

A mammogram is imaging, not genetics. It is an X-ray of breast tissue. BRCA testing is analysis of BRCA1 and BRCA2. If the question is what this thickening is, you need a clinician to assess the breast. That is a different appointment from this enquiry.

Pelvic symptoms, including pain or abnormal bleeding, belong with gynaecology, not with a BRCA form. Dr Naoum is a consultant gynaecologist, and that still does not make a genetics enquiry the right booking for a current pelvic problem. Severe bleeding or feeling acutely unwell is NHS urgent care, not a planned Harley Street slot.

What the package includes, and what a result cannot do

The package includes counselling, gene analysis, a results consultation and a written report. That is the private BRCA1 and BRCA2 panel as offered here. It is not a breast-screening package, and it is not a substitute for NHS screening programmes.

A result is reviewed at the results consultation. A finding that a gene change is present does not mean you have cancer now. A finding that no change was identified in BRCA1 or BRCA2 does not mean you cannot develop breast or ovarian cancer, and it does not mean relatives have been tested. Variants that are hard to interpret can also appear. Those meanings are explained in the room, with the written report.

The result does not replace screening or a lump clinic, and it does not, by itself, tell you which medicines to start or which operations to have. Further specialist referral may still be needed after the mini consultation, or after a result. An extra fee is explained before any such referral is arranged. If the mini consultation shows that testing is not suitable, you should hear that before a laboratory form is completed.

Send a genetic testing enquiry, or call the clinic. You do not walk in for this test. Bring a medicine list, family-history notes, and letters that already mention a BRCA result in a relative. Medical Express Clinic has practised at 117a Harley Street since 1984 and is CQC-registered. Laboratory analysis follows counselling.

Tips and tricks

• Decide which question you have before you enquire.
• Inherited risk in a family with several relatives affected, young-age breast cancer, a known mutation, or a personal history a clinician may think relevant can belong with a BRCA enquiry.
• A lump you can feel needs clinical assessment of the breast, a picture of the breast is imaging, pelvic pain or bleeding is gynaecology, and acute illness is NHS urgent care.
• Write the family history down.
• Who had which cancer, and roughly at what age, is more useful than a vague sense that cancer runs in the family.
• If a relative already has a report, ask whether you may bring a copy.
• If you are a man enquiring, say that at the start.
• Treat counselling as the work, not as a hurdle.
• If you already have NHS genetics involvement, say so.

Things to avoid

• Do not treat BRCA testing as a same-day walk-in blood test.
• Do not complete a laboratory form in your head before anyone has taken a history.
• Do not send a genetics enquiry because you found a lump this week.
• Do not confuse a mammogram with a gene test.
• Do not bring severe bleeding or acute illness to a planned counselling slot.
• Do not invent a lifetime risk figure for yourself from a search result.
• Do not read a clear BRCA report as an all-clear from screening, and do not read a gene change as a cancer diagnosis.
• Do not assume an operation follows from a result.
• The result is reviewed at the results consultation, and it does not replace screening or a lump clinic.

If you do want to discuss BRCA1 and BRCA2 testing, the details sit on the BRCA testing page, or you can contact the clinic on 020 7499 1991.

Related guides: whether to see a GP or a gynaecologist first and what a full-body MRI can and cannot rule out.