Genetic counselling is provided for those who may be at risk of inherited breast and ovarian cancer and a few of these individuals may be offered a mutation search. If this is successful, a predictive genetic test is then offered. In this paper the counselling process is discussed and related ethical issues are raised. These include access to counselling, the use of family histories as the basis for assessing risk and the choices open to those who are at increased risk. Because relatively few families are offered a mutation search (at least in the UK) and the success rate of searches is low, predictive genetic testing is currently little used. When offered, significant numbers of family members, especially men, choose not to have a predictive test. The importance of information from the wider family is stressed for estimating risk for those who may or may not have a predictive genetic test. Collecting this information, as well as the information passed back after counselling, may have important consequences for other family members.