There has been recent literature showing that relatives of patients who test negative for a familial BRCA mutation still have a higher than population risk to develop breast cancer. Has this been incorporated into the risk models?
No. I am not sure I believe the data, and while the risk may or may not be higher, I do not think the risk is clinically significant, even if it is higher.
There is a real problem here in terms of screening and threshold for biopsy. In a very high risk family, screening compliance will be higher and threshold for biopsy will be lower, so more cancers will be found in both carriers and relatives of carriers. I think this is a spurious finding.