Communities with a higher risk of genetic variants

The NICE guideline NG241 recommends genetic testing for anyone with one or more grandparent from one of the following populations: 

• Ashkenazi Jewish
• Sephardi Jewish
• Greenlander.

This is because gene variants are more likely in people from these communities as they have been separate from other communities due to geography or culture.

These communities are more at risk of developing hereditary ovarian and/or breast cancer than people from the general population.

In England

You can have genetic testing for variants in the BRCA1 and BRCA2 genes if you have one or more Jewish grandparent of any type of Jewish origin. This the case whether you have a family or personal history of cancer. Find out more about Jewish BRCA testing.

In Wales, Scotland and Northern Ireland

As of November 2025, genetic testing for specific communities isn’t available. But it’s likely to change in future. Ask your GP what’s currently available where you live.

Choosing to have genetic testing

Deciding whether to have genetic testing might make you feel anxious. This is normal. Thinking about the possibility of getting cancer is difficult. You may also remember how you felt when your family members were diagnosed with cancer. 

Before you decide whether to have genetic testing, it can help to think about these questions: 

• How do you feel about having a genetic test?

• What will you do if the result is positive (you have a gene variant)?

• How might you feel if the test result is positive?

• If the test is negative (you don’t have a gene variant), will you feel reassured?

• Would you rather not know if you have an increased risk of cancer?

• Would you consider having preventative treatment to reduce your risk of developing breast and/or ovarian cancer if you have a gene variant?

• If you decide not to have the test, could you have regular screening for breast cancer instead?

• Do you have children that would like to have genetic testing either now or in the future? 

It’s your choice whether you have testing or not. You may be offered genetic counselling. This is an appointment to talk to a genetics specialist. The meeting will last 30 to 60 minutes and may be in person, by phone or by video call. 

In the meeting you will be able to talk about: 

• whether you’re likely to have a higher risk of certain types of cancer
• whether genetic testing is possible and will be useful
• the benefits and limits of genetic testing
• ways of managing your cancer risk.

The genetics specialist will give you information about symptoms of cancer, cancer screening and risk-reducing treatments.

Having a genetic test

If you’re a family member of someone with ovarian cancer, the steps to having a genetic test are: 

1. Your first-degree relative with ovarian cancer has a blood test to see if they have a gene variant that increases the risk of developing cancer. This happens before any relatives are tested. Their result will be ready within 12 weeks.
2. If your first-degree relative's test shows they have a gene variant, you’ll be offered cascade testing to see if you have the same gene variant. Take the letter included in your relative’s results to your GP. The letter will explain that you should be offered genetic testing for the same gene variant. Your GP will refer you to your local clinical genetics service for cascade testing.
3. The clinical genetics service will offer you a genetic counselling appointment. If you choose to have the genetic test, you’ll have a blood test to find out if you have the same gene variant as your family member. Your result typically takes around four weeks to come back.

Your clinical genetics team will share your results with you. If you have a gene variant, they will give you a personalised risk assessment. This will explain your increased risk of cancer linked to the gene variant you have. You will also be offered genetic counselling to support you and help you to manage your increased risk of cancer. 

Managing an increased risk of ovarian cancer

You have a greater chance of developing ovarian cancer than people without a gene variant if you have inherited a variant in one of the following genes:

• BRCA1
• BRCA2
• RAD51C
• RAD51D
• BRIP1
• PALB2
• MLH1
• MSH2
• MSH6.

Find out more about the gene variants that increase the chance of developing certain cancers like ovarian cancer and breast cancer.

Your genetics counsellor will explain your increased risk of developing ovarian cancer and the risk-reducing options available to you. 

Risk-reducing surgery for ovarian cancer

Risk-reducing surgery is the best way to manage your increased risk of ovarian cancer. This is surgery to remove the ovaries and fallopian tubes. It greatly reduces the risk of ovarian cancer but it doesn’t completely remove the risk.

The operation is called a risk-reducing bilateral salpingo-oophorectomy (RRSO). You may also hear it called preventative surgery. This is usually keyhole surgery (where only small cuts are made) and doesn’t usually take long to recover from.

You will be supported by a team of specialists to decide whether risk-reducing surgery is right for you.

You will be offered risk-reducing surgery no earlier than 35 to 45 years old depending on which gene you have a variant in. You may choose not to have this operation straight away because: 

• you want to have children first

• you want to avoid surgical menopause (starting menopause because your ovaries have been removed)

• you may not be well enough to have surgery and so want to wait until the operation is less of a risk. 

If you choose to have risk-reducing surgery, your surgeon will remove your fallopian tubes and ovaries. It’s important that they are carefully examined by a pathologist (a specialist that looks for cancerous cells). In around 1 in 20 women precancer (cells that can go on to become cancerous) or early cancer cells may be found despite having normal scan and blood test results. That’s why some people may need more treatment after risk-reducing surgery. Your surgeon will talk to you about this possibility before your operation.

If you have risk-reducing surgery, there’s still a very small remaining chance of developing primary peritoneal cancer. The peritoneum is a large, thin sheet of tissue that lines the organs in the abdomen (tummy). It can’t be removed during risk-reducing surgery. Primary peritoneal cancer is treated in the same way as ovarian cancer. 

Surgery to remove the ovaries may also reduce the risk of breast cancer, mainly for those with a BRCA2 gene variant. It has also been shown to improve breast cancer outcomes in those who have a BRCA1 and BRCA2 variant who had breast cancer before having risk-reducing surgery for ovarian cancer. 

In future it may be possible to have risk-reducing surgery in two stages: 

1. Having your fallopian tubes removed first as ovarian cancer is thought to start in the fallopian tubes.

2. Having your ovaries removed later, nearer to the menopause. This can delay the start of the menopause while still protecting you from ovarian cancer.

In the UK, this two-stage risk-reducing surgery is only available in the PROTECTOR trial. 

Regular screening for ovarian cancer

A CA125 blood test isn’t a reliable enough marker to be used for ovarian cancer screening for the general population. But you may be able to have a regular screening test for ovarian cancer if you have a BRCA1 or BRCA2 gene variant and choose not to have or to delay risk-reducing surgery for ovarian cancer. 

When we published this information (November 2025), this screening test is currently only available in the North Central London NHS Trust. If you’re thinking about delaying or not having risk-reducing surgery, ask the specialists in your team if the screening test is now available where you live.

Research is ongoing to develop ovarian cancer screening tests for everyone. Cervical screening tests (sometimes called smear tests) don’t detect ovarian cancer.

Taking the contraceptive pill

Anyone who has ever taken the oral contraceptive pill is much less likely to develop ovarian cancer than those who have never used it. Research shows that taking the contraceptive pill can reduce the risk of developing ovarian cancer and taking it for 10 years or more further reduces the risk.

It's possible that taking the contraceptive pill may increase the risk of developing breast cancer if you have a BRCA1 or BRCA2 variant. Some studies suggest an increased risk while others haven’t found this link.

If you’re thinking of taking the oral contraceptive pill talk to your GP, breast unit team or genetic counsellor and mention that you have a gene variant. They will consider your personal risk of breast and ovarian cancer and the risks and benefits of taking the contraceptive pill.

Managing an increased risk of breast cancer

Depending on the gene variant you have inherited, you may also have an increased risk of developing breast cancer. Your genetics counsellor will explain your increased risk of developing breast cancer and the risk-reducing options available to you. 

Depending on your level of risk of developing breast cancer, you may be offered:

• more breast screening with a yearly mammogram and/or MRI from the age of 25 or older
• medical prevention, where you take medicines to reduce your risk
• risk-reducing surgery (removal of both breasts).

To find out what risk-reducing options you can have, speak to your clinical genetics team.

More information about risk-reducing options for breast cancer.

Family planning options

There are several family planning options if you have a gene variant and you want to avoid passing on to your future children. You can:

• Have children without any intervention. Each child would have a 50 per cent (1 in 2) chance of inheriting the gene variant.
• Use donor eggs or donor sperm depending on who carries the gene variant to avoid passing it on. This is where eggs or sperm are collected from someone else and given to you for fertility treatment.
• Have pre-implantation genetic testing (PGT). This is a type of genetic test to help couples who have a high likelihood of passing on a genetic condition to their child.
• Adopt children, where a child or siblings who can't be brought up within their birth family become permanent legal members of a new family.

You will be able to talk to your clinical geneticist or genetic counsellor about family planning. They will explain the options and the funding available. 

Insurance

The Code on Genetic Testing and Insurance is an agreement between the UK Government and the Association of British Insurers (ABI). It means that anyone who has had a genetic test for variants in genes that increase the risk of cancer can take out life and critical illness insurance cover without sharing the results of the test. This agreement has been in place since October 2018. Having a genetic test for hereditary ovarian cancer would also not affect your ability to get a mortgage or the terms of this loan. 

Last reviewed: November 2025

Next review: November 2028

We are PIF TICK accredited. That means you can trust that our information is based on the latest evidence, regularly updated and easy to follow. To learn more about our review process, take a look at our information standards. 

References

Below is a sample of the references used in our genetic testing and hereditary ovarian cancer information. If you'd like more information about the sources we use, please email us at [email protected]

• NICE. Ovarian cancer: identifying and managing familial and genetic risk. NICE guideline [NG241] Published: 21 March 2024. Available from: nice.org.uk/guidance/ng241 [Accessed November 2025]
• Manickam K, Buchanan AH, Schwartz MLB, et al. (2018) Exome Sequencing-Based Screening for BRCA1/2 Expected Pathogenic Variants Among Adult Biobank Participants. JAMA Netw Open. 1(5):e182140. Available at DOI: 10.1001/jamanetworkopen.2018.2140 [Accessed November 2025]
• Cancer Research UK. Genetic testing for cancer risk. Available at: cancerresearchuk.org/about-cancer/causes-of-cancer/inherited-cancer-genes-and-increased-cancer-risk/genetic-testing-for-cancer-risk [Accessed November 2025]