From the Guidelines
Yes, BRCA testing can be performed on an 80-year-old patient. There is no upper age limit for genetic testing for BRCA1 and BRCA2 mutations. While BRCA testing is often discussed for younger individuals who might benefit from enhanced screening or preventive measures, older patients may still choose to undergo testing for several reasons. The results could provide valuable information for family members who might be at risk, guide treatment decisions if the patient develops cancer, or help explain a personal or family history of cancer.
Key Considerations
- The testing process involves a simple blood draw or saliva sample, which is then sent to a laboratory for DNA analysis.
- Before proceeding with testing, the patient should receive genetic counseling to understand the potential implications of the results, including psychological impacts and possible insurance considerations.
- The decision to pursue BRCA testing should be individualized based on the patient's personal and family history of cancer, their health status, and their personal preferences regarding knowing this genetic information, as recommended by the American Society of Clinical Oncology 1 and the National Society of Genetic Counselors 1.
- Recent guidelines from the Journal of Clinical Oncology also support genetic counseling and testing for patients with suspected hereditary breast-ovarian cancer syndrome, including those with a personal history of breast or ovarian cancer 1.
From the Research
BRCA Testing in Older Adults
- There is evidence to suggest that BRCA testing can be done on older adults, including those over 80 years old 2.
- A study published in 2020 found that the rate of positive BRCA test results among women 65 years of age or older decreased from 85.7% in 2008 to 55.6% in 2018 2.
- The same study found that women with positive test results were more likely to be non-Hispanic Black women, to live in the West or South, to live in areas with a low percentage of college graduates, or to not have a personal history of breast or ovarian cancer 2.
- Clinical practice guidelines for BRCA1 and BRCA2 genetic testing have been updated to include recommendations for testing in older adults, particularly those with a personal history of breast or ovarian cancer 3.
- A practical consensus recommendation on when to do BRCA testing suggests that testing should be considered in individuals with a personal history of breast or ovarian cancer, regardless of age 4.
- A scoping review and ethical primer on BRCA1/2 testing found that ethical discussions around testing revolve around issues such as test distribution, choice to undergo testing, and reproductive decision-making, and that multidisciplinary ethical discussion is necessary to guide individual decision making and societal practices 5.