How Do You Know If You Have a Hereditary Cancer Risk?

Most people with a hereditary cancer mutation don't know they carry one. Mutations are present from birth, produce no symptoms, and can be silently passed down across generations before a diagnosis brings them to light or before proactive testing reveals them.
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Family History: What Patterns to Look For

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Family history is the most accessible and most underutilized tool for assessing hereditary cancer risk. Medical guidelines from the American Cancer Society and the National Cancer Institute identify several patterns that may suggest a hereditary cancer syndrome: (NCI, Genetic Testing Fact Sheet)

• Multiple close relatives (first- or second-degree) with the same cancer type
• Cancer diagnosed at an unusually young age (e.g., breast cancer before 50, colorectal cancer before 45)
• A family member with two or more primary cancers
• Rare cancer types (e.g., male breast cancer, ovarian cancer at any age)
• Cancer in multiple generations on the same side of the family

A family history with one or more of these features warrants discussion with a physician and consideration of genetic counseling.
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Hereditary cancer risk genetic testing analyzes DNA, typically from a cheek swab, saliva, or blood sample, for mutations in genes associated with elevated cancer risk. Panel testing has become the standard approach, examining dozens of relevant genes simultaneously rather than one gene at a time.
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A comprehensive hereditary cancer panel may test for 20-80+ genes depending on the panel used. Results generally fall into three categories:

• Positive: A pathogenic or likely pathogenic mutation is identified. This is an actionable finding; the individual should work with a genetic counselor and a physician to develop a surveillance and risk-reduction plan.
• Negative: No mutation was detected in the genes tested. This reduces (but does not eliminate) hereditary cancer risk, as some mutations may not yet be characterized.
• Variant of uncertain significance (VUS): A DNA change was identified, but its clinical impact is not yet well-established. VUS findings require monitoring as research continues.

Your genetic information is private and protected, accessible only to you and your care team.

Who Should Consider Genetic Testing?

Genetic testing for hereditary cancer risk is appropriate for anyone who:

• Has a personal or family history pattern suggestive of hereditary cancer
• Has a known family member with a pathogenic mutation in a hereditary cancer gene
• Has been diagnosed with cancer at an early age or with rare features
• Wants to proactively understand their inherited risk as part of a comprehensive health strategy

Testing is not only for people who have been diagnosed. It is increasingly used by prevention-oriented individuals who want accurate biological data to guide health decisions, particularly those who recognize that family history alone isn’t the whole picture.
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What to Do If Cancer Runs in Your Family

Learning that cancer runs in your family, or receiving a positive genetic test result, is information. And information, when acted upon with the right clinical support, is an advantage.

Talk to a Genetic Counselor

A genetic counselor is a board-certified specialist trained to assess hereditary cancer risk, explain testing options, and help individuals interpret results in the context of their family history. For anyone with a concerning family history pattern or a positive test result, genetic counseling is the essential first step.

Genetic counselors help with:

• Determining which testing panel is appropriate
• Interpreting test results, including variants of uncertain significance
• Communicating risk to other family members who may be affected
• Developing a personalized surveillance and risk-reduction plan in coordination with a physician

Increased Screening and Surveillance

For individuals with confirmed high-risk mutations, standard screening intervals are often insufficient. Medical guidelines recommend enhanced surveillance protocols:

• BRCA1/BRCA2 carriers: Annual MRI in addition to mammography, beginning as early as age 25–30 depending on guidelines
• Lynch syndrome carriers: Colonoscopy every 1–2 years beginning at 20–25, and gynecologic surveillance for female carriers
• PALB2, ATM, CHEK2 carriers: Individualized protocols based on variant and family history

The rationale is straightforward: when cancer is detected at its earliest stage, Stage 1, the localized, five-year survival rate can exceed 90% for many localized cancers. That number drops significantly when cancer is found after it has spread. Early, targeted surveillance makes early detection achievable. (NCI SEER Database)

Proactive Risk Reduction Options

For individuals at the highest inherited risk levels, additional risk-reduction options may be appropriate, discussed with and managed by a physician:

• Risk-reducing medications: Tamoxifen and aromatase inhibitors may reduce breast cancer risk in high-risk individuals. Aspirin has been studied for Lynch syndrome-associated colorectal cancer risk.
• Prophylactic surgery: Risk-reducing mastectomy and oophorectomy are options for BRCA carriers with a very high lifetime risk. These are major decisions requiring extensive counseling.‍
• Lifestyle optimization: While lifestyle factors do not override genetic risk, avoiding smoking, maintaining a healthy weight, and limiting alcohol may help reduce overall cancer risk.

How Proactive Genetic Testing Fits Into Precision Health

Precision health uses information about biology, including genetics, along with environmental, behavioral, and social factors to guide more personalized health decisions and interventions. Hereditary cancer risk testing is one of the most clinically validated applications of precision health available today.
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For the roughly 1 in 3 individuals who will be diagnosed with cancer in their lifetime, the gap between what standard healthcare provides and what precision medicine makes possible is significant. Standard care rarely includes proactive genetic risk assessment unless prompted by a family history conversation or a personal diagnosis. Individuals who seek out that assessment independently may gain access to: (American Cancer Society, Cancer Facts & Figures)

• Personalized surveillance protocols aligned to their specific mutation and risk profile
• A clinical framework for interpreting and acting on genetic results
• Earlier intervention windows that standard population screening does not routinely offer
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Frequently Asked Questions
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Is cancer always passed down from parents?

No. Only 5–10% of cancers are caused by inherited mutations passed from parent to child. The majority of cancers are sporadic, caused by a combination of environmental exposures, lifestyle factors, and random DNA changes that accumulate over time. However, if a parent carries a hereditary cancer risk mutation, each child has a 50% chance of inheriting it.

Can you get cancer if no one in your family has had it?

Yes. Since most cancers are sporadic, the absence of family history does not eliminate risk. Additionally, hereditary mutations can be present in a family without a prior diagnosis if family members died young of other causes, if the mutation has variable expression, or if the relevant relatives have not yet been tested.

Does a positive BRCA test mean you will get cancer?

No. A positive BRCA1 or BRCA2 result means your lifetime risk of certain cancers, including breast and/or ovarian cancer, is significantly elevated, not that a diagnosis is inevitable. Many BRCA carriers live their full lives without developing cancer. The value of knowing is that it enables enhanced surveillance, earlier detection, and informed conversations with physicians about risk-reduction strategies.

Is hereditary cancer testing covered by insurance?

Coverage varies widely and depends on the individual's health plan, their clinical history, and whether a genetic counselor has established medical necessity. The Genetic Information Nondiscrimination Act (GINA) offers some federal protections against discrimination by health insurers and employers based on genetic information, but it does not guarantee testing coverage. Individuals who pursue genetic testing proactively, outside of a clinical diagnosis, may not have costs covered. Consulting with a genetic counselor before testing can help clarify likely coverage and options.

What is the difference between BRCA1 and BRCA2?

Both BRCA1 and BRCA2 are tumor suppressor genes, and mutations in either elevate the risk of certain cancers, including breast and ovarian cancer. However, they are distinct genes with some differences in risk profile. BRCA1 mutations are generally associated with higher ovarian cancer risk and more aggressive breast cancer subtypes. BRCA2 mutations are more strongly associated with male breast cancer and pancreatic cancer. 
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Cancer Risk Testing Starts Here
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Most people who carry a hereditary cancer risk mutation don't know it. Not because the information is unavailable, but because most healthcare systems are designed to react, not to proactively reveal what's already written in your biology.
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Understanding whether you carry an inherited cancer risk mutation is one of the most concrete, actionable things you can do to make proactive health decisions. It doesn't require a diagnosis. It doesn't require a crisis. It requires curiosity and a willingness to act on what your DNA can tell you before something else does.
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That’s why Kadance members receive access to hereditary cancer risk testing covering 26 genes, including BRCA1, BRCA2, and the primary Lynch syndrome genes, through Kailos Genetics, its CAP-accredited, CLIA-certified laboratory partner. 
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Every gene was selected based on strong scientific evidence from established sources, including CDC Tier 1 Genomic Applications, ClinVar, and ClinGen, and every result is actionable. Membership also includes genetic counseling to help interpret positive results and a clinical foundation for discussing findings with a physician.

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This article is provided for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Readers should consult a qualified healthcare professional with questions about their health, testing, or care decisions. The information in this article is general in nature and may not reflect the full scope, terms, or availability of services included in a Kadance membership.