"When we provided navigation to help people through the testing process, we noticed a meaningful difference in utilization and how soon people completed their testing. This creates new opportunities to enhance screening, prevention and early intervention for several hereditary cancers."

How the trial worked

The researchers enrolled 286 first-degree relatives — parents, siblings and children — of 151 individuals recently identified as carrying BRCA1 or BRCA2 mutations. These mutations are well known to raise the risk of breast, ovarian, prostate and other cancers.

The trial split participants into two groups. One group entered a facilitated testing program that included navigation support and streamlined access to genetic testing services. The other group received the standard of care: a family notification letter informing them of their potential inherited risk.

The difference was clear. Beyond the six-month jump from 51% to 73% uptake, 90% of relatives in the facilitated testing group completed testing by the 18-month mark.

Of the 206 relatives who completed testing, 46% were found to carry a BRCA1 or BRCA2 mutation associated with a higher risk of cancer. Among that group, 86% carried the exact same familial mutation that had already been identified in their relative.

What the findings suggest

Genetic testing can reveal inherited cancer risk long before symptoms appear, opening a window for early intervention that can prevent disease or catch it at a treatable stage. The study's findings suggest that programs combining two elements — identifying and informing relatives of their inherited cancer risk, and actively helping families navigate cascade testing — have real potential to improve health outcomes across entire families.

Put simply, information alone does not change behavior. Guidance does.

As with any single trial, caution is warranted before drawing broad conclusions. The study focused on relatives of BRCA1/2 carriers at a major cancer center, and it remains to be seen how the approach performs across different healthcare settings and other cancer-related genes. Still, the magnitude of the increase in testing uptake — and the speed with which people completed testing — suggests navigation could become a practical tool for closing a long-recognized gap in hereditary cancer care.

The study appears as: Roni Nitecki Wilke et al., "Facilitated Cascade Genetic Testing for Relatives of Individuals With BRCA1/2 Pathogenic Variants: A Randomized Controlled Trial," Journal of Clinical Oncology (2026). DOI: 10.1200/jco-26-00735.