OBJECTIVE: The risk cut off to recommend BRCA 1 and 2 gene testing varies from 10% for the American Society of Clinical Oncology to 20% in European countries. Considering pts with a previous diagnosis of breast cancer, we aimed to establish a risk cut off policy for genetic testing at our service, in terms of direct costs. A total of 130 pts with a previous breast cancer, in routine follow-up, received invitation to schedule consultation in the hereditary breast cancer unit. METHODS:Of these, 77 patients, were interviewed by a multidisciplinary team, and had their risk assessed based on family pedigree and confirmed pathological information (Frank Ts et al, JCO 20:1480-1490, 2002). Direct costs of genetic testing were considered as the sum of costs of reagents, permanent equipment and personnel excluded. Prices in reais were converted to dolar (2.3 reais per dolar). RESULTS: Our survey have shown that 3 women in 77 surveyed were to be tested with a risk cut off established in 20% as compared to 16 with a risk assessment of >10%. Considering the offspring, screening those women would benefit 162 and 21 other women, respectively, at 10% and 20% cut off. The total direct costs of gene testing would be $31,023.86 at 10% and $5,816.97 at 20%. In case we consider all first degree women relatives as beneficiaries, independent of the result being positive or negative for BRCA mutation, cost effectiveness (CE) ratio of $191.50 per individual benefited at 10% and $276.99/beneficiary at 20%. CONCLUSION: A 20% cut off for genetic testing in this population with breast cancer seems very strict, since the number of women indicated for genetic testing was far bellow the 5% expected in breast cancer population. Considering the other family members, the higher cost associated with 10% cut off could benefit more women.