An estimated 2–5% of endometrial cancers and 15–20% of high-grade, non-mucinous epithelial ovarian cancers have an underlying hereditary cause. Appropriate risk assessment, genetic counseling, and germline genetic testing for cancer predisposition genes in both gynecologic cancer patients and their at-risk relatives is essential for effective delivery of tailored cancer treatment and cancer prevention. However, significant disparities exist within medically underserved and minority populations in the United States regarding awareness of, access to, and use of genetic services. The objectives of this review are to summarize the literature on genetic counseling and genetic testing of gynecologic cancer patients, the cascade genetic testing of their families following the identification of a germline mutation associated with susceptibility to cancer, to highlight disparities between populations, and to present some potential remedies. •Despite increases in the rate of testing for BRCA and Lynch syndrome, many high-risk women remain unidentified.•Underserved populations who do not access genetics services are at risk of missing opportunities for cancer prevention.•Socioeconomic factors, poor communication, concerns about misuse of genetic data contribute to poor use of genetic services.•Research is needed to specifically identify barriers to receipt and use of cancer genetics services.