BRCA1 and BRCA2 mutations are associated with a high lifetime risk of breast and ovarian cancer, and require close monitoring. The sensitivity of current imaging sense modality is limited, and the tissue biopsy is ethically and practically difficult in asymptomatic patients. Recent advances have identified a unique population of pre-cancer associated fibroblasts (pre-CAFs) that are characterised by dual overexpression of Podoplanin (PDPN) and CD10 (PodPDPN/CD10) in histologically normal breast tissue from BRCA1/2 carriers, the earliest stromal remodelling event prior to malignant transformation. This tissue-based signature offers insights into mechanisms, but is hampered by the need for invasive sampling for clinical use. This review summarizes the current state of the art of non-invasive liquid biopsy alternatives, such as soluble PDPN (sPDPN), cell-free DNA (cfDNA) methylation signatures, and, most promisingly, exosomal microRNA (miRNA) cargo. We emphasize that although circulating free miRNA is highly unstable, exosomal lipid bilayer vesicles provide biological protection and allow for paracrine/endocrine reprogramming of distant epithelial cells. The future of stromal biology and exosomal transcriptomics is one in which a simple blood test may be able to predict the onset of carcinogenesis in high-risk BRCA1/2 populations, leading to truly personalised prevention.