Background: Support for universal genetic testing after diagnosis of breast cancer is growing because of concerns that more narrowly targeted guidelines fail to identify all patients who could benefit from genetic risk evaluation (GRE). Little is known about use of genetic testing in survivors of breast cancer over time. Methods: Women who were diagnosed with breast cancer in 2014-15 and reported to the SEER registries of Georgia and Southern California completed a baseline survey about 9 months after diagnosis (N=2502) through the iCanCare study. We performed a follow-up survey (FUPs) about 6 years after diagnosis for 2347 survivors of whom 1430 responded (60% response rate). We asked women about their receipt of clinical germline genetic testing and results, communication with relatives about cancer genetic testing, and use of direct-to-consumer testing (DTCt) after diagnosis. We categorized women into indications (yes/no) for GRE based on clinical guidelines published at time of diagnosis (GRE indication baseline) and at the time of the follow-up survey (GRE indication FUPs only). Results: About half of the respondents (44.6%) had indications for GRE over the study period; 28.0% had an indication at baseline; and an additional 16.6% had an indication by time of the follow-up survey (FUPs only). The Table shows patient-reported testing at FUPs by GRE indication category (baseline, FUPs only, no indication). About two thirds of those with a baseline indication for GRE received genetic testing over the study period: 66.5% vs 43.9% with indication at FUPs only vs 35.0% of those with no indication (p<.001). There were no significant race and ethnic differences in receipt of testing across clinical indications (p=.356). Testers with a pathogenic variant result (n=59) were much more likely to have talked to most or all of their close adult relatives about genetic testing than those with a variant of unknown significance (n=48), or a negative finding (n=384): 64.3% vs 35.0% and 37.1%, respectively (p<.001). Overall, there was very little interest in DTCt for cancer risk: 5.0% researched these tests online somewhat to a lot; and only 3.5% got a DTCt. Conclusions: The proportion of patients with indications for GRE after diagnosis of breast cancer markedly increases in survivorship but many patients do not get genetic testing. Lack of survivor interest in DTCt for cancer risk is reassuring that patients are not substituting these tests for clinical testing. These findings support the growing appeal for universal germline genetic testing for patients with breast cancer.