Inherited Cancer Risk Doesn't Stop at 70, and Neither Should Genetic Testing

Interview and article by Pamela Pont

Dr. Dana Chase and colleagues reviewed genetic test results from more than 113,000 people with ovarian cancer. About 1 in 15 of those diagnosed at 70 or older carried an inherited gene change linked to the disease, yet older patients were less likely to report a family history of cancer. That means testing decisions based on age or family history could overlook older women who carry these gene changes, leaving them and their relatives without information that could be important.

The paper: Shachar E, Rotkop G, Haas R, Frankenthal R, Kamara D, Demirjian M, Kwan L, Cummings S, Roscow B, Salani R, Spellman PT, Karlan B, Chase DM. "Real-world genetic testing data of ovarian cancer patients: Informing counseling and risk reduction in patients over age seventy." Gynecologic Oncology, June 2026 (published online May 11, 2026), 209:77-87. doi:10.1016/j.ygyno.2026.05.007

The researcher: Dr. Dana M. Chase, Professor and Fellowship Program Director, Division of Gynecologic Oncology, David Geffen School of Medicine at UCLA.

In a nutshell

Some ovarian cancers are driven by a gene change a woman was born with and may have passed to her children. Finding that change can shape her own care and give relatives the chance to get tested and take steps to prevent cancer. Doctors have long used a patient's age and family history to decide who should be offered this kind of genetic testing.

Much of the familiar information about inherited breast and ovarian cancer risk describes risk up to about age 70. Dr. Chase's team asked what happens after that. They looked at testing records for 113,236 people with ovarian cancer tested through a large commercial testing registry between 1996 and 2024.

About 1 in 5 of the patients tested (22,593 people) were diagnosed at age 70 or older. Among them, 6.6% carried a harmful inherited change in a gene known to raise ovarian cancer risk, compared with 12.8% of those diagnosed before age 70. In other words, these gene changes are found less often in women diagnosed at older ages, but they are far from rare: about 1 in 15 women diagnosed at 70 or older still carried one.

The team also found that patients 70 and older were about 1.5 times less likely to report a family history of cancer. In other words, family history becomes a weaker signal at exactly the age when doctors may be least likely to think about inherited risk.

The researchers conclude that genetic counseling and testing for ovarian cancer should not be limited by age or by family history.

Why this group of patients matters

Women 70 and older make up a large share of people with ovarian cancer, yet they are underrepresented in hereditary cancer guidelines. The paper notes that there is little age-specific guidance on whether older carriers should continue, change, or stop screening and prevention steps, which leaves patients and doctors uncertain.

That uncertainty shows up in practice. In this registry, older patients were less likely to have been tested: 52.5% of those 70 and older, compared with 57% of those under 70.

Dr. Chase saw the same gap in clinic. "We repeatedly encountered women in their 70s and older who were uncertain about whether hereditary cancer risk was still relevant to them, both for genetic testing and for decisions about screening or risk-reducing surgery," she said. Because traditional counseling has focused on risk through about age 70, she explained, it "can unintentionally create the impression that genetic risk becomes clinically unimportant beyond that age."

The stakes reach beyond the patient. "A 75-year-old with ovarian cancer can still carry a clinically actionable hereditary cancer variant," Dr. Chase said. "The result may affect her own treatment or future cancer management, and it can be extremely important for her children, grandchildren, and other relatives."

How they found it

The question started with patients who did not fit the usual picture. "We were seeing older women diagnosed with ovarian cancer without a striking family history who nonetheless carried pathogenic germline variants," Dr. Chase said. (A pathogenic germline variant is a harmful, inherited gene change present in every cell of the body.) "That disconnect made us question whether age and family history were being given too much weight when deciding whom to test."

The team chose 70 as its dividing line not because anything biological happens at that birthday, but because it is where much of the published risk information stops. "We were less interested in suggesting that age 70 represents a biologic threshold than in asking what happens beyond the age range on which much of our conventional hereditary cancer counseling has been based," she said. First author Dr. Eliya Shachar led the study design and analysis, with Dr. Chase as senior author and collaborators from Myriad Genetics, which maintains the testing registry.

The expected result was that inherited gene changes would be rare in older patients. They were less common, but still present at meaningful rates. The mix of genes also shifted with age:

• BRCA2 outnumbered BRCA1. Before 70, BRCA1 is the more common finding. In patients 70 and older, BRCA2 was more common. Dr. Chase sees "probably a true biologic component," since BRCA1-related ovarian cancers tend to appear at younger ages. But she cautioned that survivorship and referral patterns "almost certainly contribute as well," and called the finding "biologically plausible and clinically interesting, but not as proof that BRCA2 truly becomes more common than BRCA1 in the underlying population after age 70."
• Some genes held steady or grew more common. Changes in BRIP1 and PALB2 were enriched in patients 70 and older, while ATM, RAD51C, and RAD51D stayed relatively stable across ages. Dr. Chase explained that BRIP1 is known from earlier studies to cause ovarian cancer later in life than other established genes.
• Lynch syndrome genes declined with age. Lynch syndrome is an inherited condition best known for raising colon and uterine cancer risk. Changes in PMS2, one Lynch syndrome gene, were more common than previously reported and declined with age.

Family history also turned out to be a blunt tool. According to Dr. Chase, a detailed family history score weighted by how closely relatives were related performed worse than a simple yes-or-no question about family cancer history. "A weighted score sounds more sophisticated, but it also introduces more opportunities for measurement error," she said. Patients may not know relatives' exact diagnoses, and smaller families can look less affected than they are.

Put together, the reasoning runs in a straight line. Inherited gene changes become less common with age. They remain present in about 1 in 15 older patients tested. Older patients are less likely to report a family history. So family history cannot be relied on to find them. "The absence of family history is not sufficiently reassuring," Dr. Chase said.

What it could mean for patients

Offering testing regardless of age. This study used real-world testing records from patients, not a clinical trial. It shows that a meaningful share of older women with ovarian cancer who were tested carried an inherited gene change. Dr. Chase's message for clinicians is direct: "Do not let age or the absence of a strong family history dissuade you from offering germline genetic testing."

Protecting relatives. A result in an older patient can open the door to testing for her children, grandchildren, and other family members, known as cascade testing. "The value of testing an older patient extends well beyond that individual patient," Dr. Chase said. Whether identifying older patients actually leads to more relatives being tested and to cancers being prevented has not yet been measured; it is one of the questions she wants to study next.

Multiple cancers over a lifetime. The paper points to the burden of additional cancers among older carriers. Dr. Chase noted that older BRCA1 and BRCA2 carriers had higher rates of multiple primary cancers, meaning separate new cancers rather than a return of the first one. "Some of these women may represent missed opportunities for earlier genetic testing," she said, though she added that women who live into their 70s and 80s "simply have more time in which to develop multiple primary cancers."

Prevention surgery is an individual decision. The authors suggest that risk-reducing removal of the ovaries and fallopian tubes (called RRSO) may be considered for some older carriers, since there is no effective screening test for ovarian cancer. Dr. Chase stressed that this conversation is "fundamentally different" from one with a 40-year-old carrier. For a woman in her 70s, "competing mortality, comorbidities, surgical risk, and personal preferences become much more important," and the decision "should be individualized according to the gene-specific remaining risk, overall health, life expectancy, prior surgeries, competing risks, and the patient's values."

What this does not mean yet. This study looked back at people who had already been tested. It did not test a new screening or prevention approach in a clinical trial, and nothing here is a new treatment. Dr. Chase was clear about its main limitation: "Our denominator consists of women who underwent genetic testing, not all women with ovarian cancer, so referral and testing practices inevitably influence the observed prevalence." As a result, the data cannot say for sure whether inherited gene changes truly become less common with age or whether older women with those changes were simply tested less often. "If anything, systematic under-testing of older patients could mean that hereditary susceptibility in this population has historically been underestimated," she said. Findings about specific genes, especially PMS2, where the link to ovarian cancer is "clearly less established," should be read cautiously. Anyone with questions about genetic testing or prevention should talk with their doctor or a genetic counselor.

The [funder] grant

[Needs material from Dr. Chase. The interview materials do not cover funding: when she applied, at what career stage, what the grant made possible, and what it meant to her. Confirm whether this work was OCRA-funded before keeping this section.]

The publication timeline, from the journal record: the paper was submitted on April 1, 2026, revised on May 1, accepted on May 4, and published online on May 11, 2026. The data behind it span nearly three decades of genetic testing, from 1996 to 2024.

What's next

These are studies Dr. Chase described wanting to do, not results. None of them has been published.

How common are inherited gene changes when everyone is tested? Dr. Chase's proposed next step is a prospective, population-based study in which every patient with ovarian cancer is tested "regardless of age, family history, histology, or clinician referral patterns." That design would separate true age-related differences from the bias built into who gets referred for testing today.

Do tumors in older carriers behave the same way? She would like to link inherited test results with tumor sequencing, treatment, and long-term outcomes. Paired data could show whether cancers in older carriers keep the same DNA-repair weaknesses, and the same treatment vulnerabilities, seen in younger patients.

Does testing older patients actually prevent cancer in families? A second direction is measuring what happens after a result: how often it changes the patient's own care, how often relatives get tested, and whether finding an older carrier leads to prevention in the next generations. "Ultimately, that is probably the most important endpoint," Dr. Chase said.

In her own words

What first made you suspect that family history and standard testing criteria were failing older ovarian cancer patients?

In clinic, we repeatedly encountered women in their 70s and older who were uncertain about whether hereditary cancer risk was still relevant to them, both for genetic testing and for decisions about screening or risk-reducing surgery. At the same time, we were seeing older women diagnosed with ovarian cancer without a striking family history who nonetheless carried pathogenic germline variants. That disconnect made us question whether age and family history were being given too much weight when deciding whom to test.

Why include PMS2, given the limited evidence linking it to ovarian cancer?

We discussed this carefully, because the association between PMS2 and ovarian cancer is clearly less established than for genes such as BRCA1, BRCA2, BRIP1, RAD51C, or RAD51D. Ultimately, we included PMS2 because it is an established Lynch syndrome gene and ovarian cancer remains part of the broader Lynch-associated tumor spectrum, even though the magnitude of risk attributable specifically to PMS2 appears substantially lower and remains uncertain. We felt it was more informative to include it transparently and interpret the findings cautiously than to exclude potentially clinically relevant carriers altogether.

What does it mean when an older woman with ovarian cancer has already had another cancer?

Some of these women may represent missed opportunities for earlier genetic testing. Had the hereditary syndrome been recognized after their first cancer, they or their relatives may have had opportunities for intensified screening, risk-reducing surgery, or other preventive interventions. The important point is that finding a germline mutation in an older patient is not merely explanatory. It can still have implications for that patient's subsequent cancer risk and, importantly, for cascade testing and cancer prevention in her relatives.

How do you think about prevention surgery for an older carrier compared with a 40-year-old?

The conversation is fundamentally different. For a 40-year-old carrier, risk-reducing salpingo-oophorectomy is based on decades of remaining cancer risk. For a woman in her 70s, the absolute remaining lifetime risk is smaller, and competing mortality, comorbidities, surgical risk, and personal preferences become much more important. However, ovarian cancer at an older age alters quality of life, so prevention may still have meaningful value. The decision should be individualized.

What is the one change you want clinicians to make when seeing a 75-year-old newly diagnosed with ovarian cancer?

Do not let age or the absence of a strong family history dissuade you from offering germline genetic testing. A 75-year-old with ovarian cancer can still carry a clinically actionable hereditary cancer variant. The result may affect her own treatment or future cancer management, and it can be extremely important for her children, grandchildren, and other relatives.

Read the paper

Shachar E, Rotkop G, Haas R, Frankenthal R, Kamara D, Demirjian M, Kwan L, Cummings S, Roscow B, Salani R, Spellman PT, Karlan B, Chase DM. Real-world genetic testing data of ovarian cancer patients: Informing counseling and risk reduction in patients over age seventy. Gynecologic Oncology. 2026;209:77-87. doi:10.1016/j.ygyno.2026.05.007

Senior author: Dana M. Chase. Co-authors include Beth Karlan and Ritu Salani, with Shelly Cummings and Breanna Roscow of Myriad Genetics. [Institutions to confirm from the paper's affiliation list.]

Citation data from PubMed (PMID 42114202).