Q. A patient is concerned about her risk because her mother and an aunt have had breast cancer. She asks, “Should I get a BRCA test?”

A. Just because you have some high risk factors, does not mean you need genetic testing. The BRCA gene mutations occur in only 1 out of 800 individuals, and the factors that indicate need for genetic testing are generally:

• Getting breast cancer yourself, before age 50

• Getting two breast cancers at the same time

• Having a triple negative breast cancer

• A first-degree relative with breast cancer before age 50

• Personal history of ovarian cancer

• Breast cancer at any age, and Ashkenazi Jewish heritage

• Three or more family members with breast cancer

There are other combinations of factors that indicate the need for testing, so if you have questions about your specific need, discuss it with a health professional who is interested in genetic testing, or email us and we may be able to help, or point you to someone who can.

The most accepted method of BRCA testing is a blood test that is very expensive — approximately $3,000. If the test is recommended after formal genetic counseling, it is almost always covered by health insurance. A new test, using saliva, was introduced in 2015 at a much lower cost (around $250). Both tests require ordering by a health care provider, but the less expensive one, if not covered by insurance, is an easier out-of-pocket expense.

The reason these tests need to be ordered by a health care professional is that if they are positive for the BRCA gene mutation, you will need additional counseling and care to determine your best plan of action.

Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. In addition to taking care of patients locally, he continues to participate in research as an adjunct professor at the University of Texas Health Sciences Center. You can reach him at Mike@breastdiagnostic.com.