How to Talk to Your Family About Genetic Testing

By Amanda Shrewsbury, MS, CGC

The test results are in. You've met with your genetic counselor, you understand what the findings mean for your health, and now comes a different kind of challenge: telling your family.

For many people, this is the hardest part of the entire genetic testing process. Not the blood draw. Not the waiting. The conversation. How do you bring it up? What if they react badly? What if they don't want to hear it? What if you're still processing it yourself?

If you're feeling any of that, you're not alone, and there's no perfect way to do this. But there are approaches that make it easier, and understanding why this conversation matters can help you find the words.

Why Should You Tell Your Family About Your Genetic Test Results?

When a pathogenic variant (a disease-causing DNA change) is found in your genetic test results, it doesn't just affect you. The majority of hereditary cancer syndromes follow an autosomal dominant inheritance pattern, which means each of your first-degree relatives (parents, siblings, and children) has a 50% chance of carrying the same variant. Second-degree relatives (aunts, uncles, nieces, nephews, grandparents, grandchildren) have a 25% chance. (In rare cases, a hereditary cancer condition may follow an autosomal recessive pattern, where both parents must carry a variant for a child to be affected. Your genetic counselor will explain which inheritance pattern applies to your specific result.)

That means your test result contains information that could change the course of someone else's health. A sibling who learns they carry the family variant can start enhanced screening years before cancer might develop. A parent who gets tested can clarify which side of the family the variant came from, which narrows the circle of who else needs to know. An adult child who tests negative can be spared years of unnecessary worry.

This is exactly what cascade testing is designed to do: once a specific variant is identified in one family member, relatives can be tested for that known variant. It's a targeted, straightforward test that gives a clear yes-or-no answer and is typically covered by insurance.

And yet, research consistently shows that the majority of eligible relatives never get tested. A 2024 meta-analysis of 30 studies found that only about 33% of at-risk family members complete cascade genetic testing for hereditary breast and ovarian cancer (Ahsan et al., 2024). Other large reviews have found similarly low rates across hereditary cancer syndromes. The primary reason isn't that relatives don't care. It's that the information never reaches them in a way that leads to action.

Your conversation is the bridge.

What Makes This Conversation So Hard?

Research on family communication about genetic test results has identified several consistent barriers, and none of them are surprising if you've ever tried to bring up a sensitive health topic at a family gathering.

Not knowing what to say. Genetic testing involves terminology and concepts that can feel overwhelming to explain, especially to relatives who may not have any background in genetics. People worry about getting the details wrong or confusing their family members.

Wanting to protect others. Studies consistently find that one of the most common reasons people delay or avoid sharing results is the desire to shield relatives from worry or distress. This is especially common with older parents or family members who are already dealing with health challenges.

Strained or distant relationships. Not all family relationships are close. Sharing deeply personal health information with a sibling you haven't spoken to in years, or a cousin you've never met, can feel awkward or even impossible.

Not wanting to be the bearer of bad news. If you've tested positive for a variant associated with serious cancer risks, telling your family can feel like you're handing them a burden. There's often guilt involved, even though you didn't cause the variant and couldn't have prevented it.

Gender dynamics. Research shows that genetic test results are shared more frequently with female relatives than male relatives. Men in the family are less likely to be informed and less likely to pursue testing, even though many hereditary variants (including BRCA1 and BRCA2) carry cancer risks for men too.

Still processing it yourself. You may not feel ready to talk to anyone else about your results when you're still working through what they mean for your own health.

All of these are valid. And none of them mean you need to handle this alone.

How Do You Start the Conversation?

There's no single script that works for every family. But here are some practical approaches that genetic counselors consistently recommend:

Start with why, not what. Before diving into the technical details, explain why you're bringing this up. Something as simple as "I learned something about my health that might be relevant for you too, and I wanted to share it because I care about you" sets a tone of care rather than crisis.

You don't have to explain the science. Your job is to share the information, not to become a genetics educator. A few key points are usually enough: you were tested for inherited cancer risk, a variant was found, and your relatives may want to consider getting tested too. Your genetic counselor provides a family letter specifically for this purpose, written in plain language and designed to be shared with relatives. It explains what was found, what it means, and what steps family members can take. You don't have to carry the full weight of the explanation yourself.

Choose your method. Some people prefer face-to-face conversations with close relatives and written communication (email, text, or the family letter itself) for extended family. There's no wrong way to do it. Research shows that the method matters less than the fact that the information reaches people at all.

Don't try to do it all at once. You don't need to call every relative in a single weekend. Start with the family members you're closest to and who are most directly at risk (parents, siblings, adult children). They can help spread the information further. Research suggests that many people share results with the majority of close family members initially but don't always follow up, so building in a second round of communication, even just a brief check-in, significantly increases the chance that relatives take action.

Name the emotion. It's okay to say "This is hard for me to talk about" or "I'm still processing this myself." Being honest about your feelings actually makes the conversation feel more human and less like a clinical notification.

Provide a clear next step. Don't leave relatives wondering what to do with the information. The most helpful thing you can say is something like: "If you want to find out whether you carry this too, you can talk to a genetic counselor. Here's the letter from my counselor that explains everything."

What If They Don't Want to Hear It?

This happens, and it doesn't mean you did anything wrong. People process health information at their own pace. Some common reactions include:

Dismissiveness: "I don't want to know" or "I'm sure I'm fine." This is often driven by fear rather than indifference. The information can feel threatening, and avoidance is a natural response.

Anger or blame: Sometimes family members direct frustration at the person sharing the news, even though you're trying to help. This can be especially painful.

Minimizing: "That doesn't apply to me" or "I'm a man, so it doesn't matter." This reflects common misconceptions about hereditary cancer, particularly the false belief that BRCA and similar variants only affect women.

Delayed response: Someone who dismisses the information today may come back to it months or years later. Many genetic counselors report that relatives who initially declined testing eventually circle back.

The most important thing to remember is that you've done your part by sharing the information. You can't control what someone else does with it. What you can do is make sure the information is available and the door is open if they change their mind.

What About Talking to Children?

If you have children, the question of when and how to discuss your genetic test results is deeply personal. A few general principles:

For young children, the conversation can be kept very simple: "Our family has something in our genes that doctors are keeping an eye on, and we're doing everything we can to stay healthy." You don't need to introduce words like "cancer" or "mutation" before they're developmentally ready.

For teenagers and young adults, a more direct conversation is appropriate, especially if they're approaching the age when screening or testing might be recommended. Your genetic counselor can help you think through timing and language.

For adult children, the conversation is similar to telling any other adult family member. For most hereditary cancer variants, they have a 50% chance of carrying the same variant, and they deserve to make an informed choice about whether to get tested.

In all cases, your genetic counselor can help you prepare for these conversations and can provide age-appropriate resources.

Your Genetic Counselor Is Your Partner in This

You don't have to figure out the family conversation on your own. At ClearPath Genetics, sharing results with family is a core part of what we help patients navigate. When you test positive, your counselor provides:

A personalized results letter documenting your findings and recommendations for your own healthcare providers.

A family letter written in plain language, designed to be shared with relatives. It explains the variant that was found, what it means for the family, why cascade testing is recommended, and how family members can access genetic counseling. (Learn more about what happens during your appointment and how results are delivered in our walkthrough: What Actually Happens During a Genetic Counseling Appointment.)

Your counselor can also help you think through which family members to tell first, how to approach difficult relationships, and how to handle common questions and reactions. If you're not sure where to start, that's one of the best things to bring up during your results session.

For a deeper understanding of what genetic test results mean and the different types of results your family members might receive through cascade testing, see our guide: What Your Genetic Test Results Actually Mean.

This Conversation Can Save Lives

It's a big statement, but the evidence supports it. Cascade testing gives at-risk family members the opportunity to catch cancer early through enhanced screening, reduce risk through preventive measures, and make informed decisions about their health before a diagnosis changes everything. Every person who gets tested because of a family conversation is one more person with options they wouldn't have had otherwise.

You already took the first step by getting tested yourself. Sharing what you learned is the next one.

Have a question? Reach out anytime:

Email: hello@clearpathgenetics.com
Text or call: +1 (720) 799-0730

References

Ahsan, M. D., Chandler, I. R., Min, S., et al. (2024). Uptake of cascade genetic testing for hereditary breast and ovarian cancer: A systematic review and meta-analysis. Clinical Obstetrics and Gynecology, 67(4), 702–710. https://doi.org/10.1097/GRF.0000000000000895

Frey, M. K., Ahsan, M. D., Badiner, N., et al. (2022). What happens in the long term: Uptake of cancer surveillance and prevention strategies among at-risk relatives with pathogenic variants detected via cascade testing. Cancer, 128(24), 4241–4250. https://doi.org/10.1002/cncr.34476

National Comprehensive Cancer Network. (2025). Genetic/familial high-risk assessment: Breast, ovarian, pancreatic, and prostate (Version 2.2025). https://www.nccn.org