A volunteer panel of national experts the US preventive Services Task Force (USPSTF) in 2013 last recommended that genetic testing be recommended for women with a family history of breast , ovarian , tubal and peritoneal cancers. That was recently updated to now include women who have in the past been diagnosed and completed treatment for breast, ovarian and tubal cancers who are now determined to be cancer free and those with ancestries with BRCA 1 and BRCA2 such as those of Ashkenazi Jewish descent
If a woman is determined on an initial assessment by her Primary Care doctor to be of high risk she should be referred for genetic counselling and then genetic testing for the mutations of BRA and other types.
Routine genetic testing is not recommended. One must realize that breast cancer though the second most common cancer in women, the genetic type is very rare. Genetic mutations are about 5 to 10% of breast cancers and 15% of ovarian cancers.
If one is found to have a cancer mutation then several steps may need to be taken to reduce one’s chances of getting cancer. Some such possibilities include taking medications or undergoing risk reducing surgeries like the ones that Angelina Jolie chose to have. This information may become important for first degree relatives and daughters. Taking the right steps is absolutely important so that one’s Health Insurance will pay for all the procedures, consultations and medications from start to finish.
There are other deviations from the usual in that there are disparities in the incidence of breast cancer ie certain minority groups have a higher incidence of breast cancer independent of personal or family histories. The Primary care Physician should make those determinations. Despite following the right procedures my own Insurance company took 2.5 years to pay for my testing expenses.