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Inherited cancer risk

At-home tests of selected variants vs clinician-ordered full-gene testing for inherited cancer risk: what each finds, what each misses, and who each suits.

By the GeneMatrix editorial teamUpdated 5 min read

A plain kit box, an empty sample tube, car keys and a blank appointment card on a hallway console.

In short

If you or a close relative has had cancer, choose the clinical route: a clinician orders a test that reads whole genes. An at-home test of selected variants checks only known positions chosen in advance, so it can miss variants and can’t rule out inherited risk. It is meant for people without that history who understand its limits.

On this page
  1. What is the difference between the two routes?
  2. When is the clinical route the right one?
  3. When can an at-home test of selected variants make sense?
  4. Where does GeneCancer fit?
  5. What an at-home or clinical result can’t tell you
  6. What to do next

What is the difference between the two routes?

Both routes look for inherited variants linked with cancer risk. The big difference is how much of each gene they read.

  • An at-home test of selected variants checks a list of known positions in each gene, chosen in advance, by genotyping. Those positions are its selected variants.
  • A clinician-ordered full-gene test reads each gene on the panel letter by letter, and can add a separate check for larger missing or repeated pieces of a gene.[7]
At-home selected variants and clinician-ordered full-gene testing, side by side
QuestionAt-home test of selected variantsClinician-ordered full-gene test
What it readsKnown positions in each gene, chosen in advanceEach gene on the panel in full, and a separate check can look for missing or repeated pieces[7]
What it can missAny variant not on its list, including many rare ones[6]Fewer variants, but no test finds everything, and some results are uncertain[1]
Who it suitsPeople without a personal or family history of cancer who understand its limitsPeople with a personal or family history of cancer, or a known variant in the family
If a variant is foundAsk your clinician to confirm it with a clinical test before any decision[8]Talked through with your clinician or a genetic counselor
If none is foundDoesn’t rule out inherited riskStill read alongside your family history[2]

Why the gap matters: harmful variants are many and each is rare, and some are missing or repeated pieces of a gene that a check of single positions can’t see. Any test of selected variants, ours included, can only find what is on its list. What a cancer gene panel can tell you sets out the studies behind that.[6][7]

The question isn’t which test is better. It is which test fits your history.

When is the clinical route the right one?

Start with the clinical route if any of these apply to you. They are drawn from the signs NCI and CDC describe of cancer that may be inherited.[1][2]

  • You have had cancer. CDC lists, for example, a personal history of ovarian, fallopian tube or primary peritoneal cancer, and breast cancer that meets criteria on age at diagnosis, type, ancestry and family history.[2]
  • A relative has a known variant in a cancer gene. Sharing the details of their exact variant helps your doctor know which test to use.[3]
  • Cancer at a young age in the family, such as colon cancer diagnosed before 50.[1]
  • Several close relatives with related cancers, such as breast and ovarian cancer, or colon and endometrial cancer.[1]
  • More than one cancer in one person, or cancer in both of a pair of organs, such as both breasts.[1]
  • A rare cancer in the family, such as breast cancer in a man.[1]
  • Ashkenazi or Eastern European Jewish ancestry together with a family history of breast and ovarian cancer.[2]
  • You have cancer now. Ask your cancer care team about genetic testing. Testing the tumor itself is a separate test that uses tissue from a biopsy or surgery.[4]

For women, the U.S. Preventive Services Task Force (USPSTF) recommends that clinicians assess anyone with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or an ancestry linked with BRCA1 or BRCA2 variants. Those at raised risk should have genetic counseling and, if it is indicated, genetic testing.[5]

For the wider picture, and each route to a test, read who should consider genetic testing for cancer.

When can an at-home test of selected variants make sense?

It can make sense if none of the signs above apply to you, and you want to know whether you carry any of the specific variants a panel checks.

Know what the evidence says first. For women whose personal history, family history and ancestry aren’t linked with BRCA variants, the USPSTF recommends against routine BRCA risk assessment, genetic counseling and testing. It found that for them the harms, which include false-positive results, extra imaging and surgery, outweigh the benefits.[5] The USPSTF didn’t review evidence for men. Its recommendation dates from 2019, and an update is in progress.[5]

If you choose to test anyway, go in knowing that:

  • It checks only its own list. Variants that aren’t on the panel aren’t tested.
  • None found isn’t an all-clear. A result with no variant found doesn’t rule out inherited risk.
  • A finding needs confirming. Findings from consumer DNA data are sometimes wrong, so a clinical test comes before any decision.[8]
  • Your history can change. If a relative is later diagnosed with cancer, or found to carry a variant, the clinical route becomes the right one, whatever your earlier result.
A family treeRelatives across three generations drawn as a pedigree, squares and circles joined by lines, as a clinician sketches a family history. No one is marked.
Your family history, sketched the way a clinician draws one, decides the route more than any test does.

Where does GeneCancer fit?

GeneCancer sits on the at-home side of the table. Checks selected variants across 108 genes, including BRCA1 and BRCA2, by genotyping. Like any test of selected variants, it can miss variants a full-gene test would find, so it doesn’t stand in for clinician-ordered testing, and a result with none found doesn’t rule out inherited risk. It suits people with no personal or family history of cancer; a variant it finds goes to your clinician for a clinical test.

Selected variants only, by genotyping. Not a full-gene test.

What an at-home or clinical result can’t tell you

  • Whether you have cancer now. Neither route diagnoses cancer. If you have symptoms, see your doctor.
  • Anything about variants a test didn’t check. A test of selected variants speaks only for the variants on its list.
  • That your risk is low. Most cancer isn’t inherited, so the screening your clinician recommends still applies, whatever your result.[1]
  • What to do next about screening, medicines or surgery. Those decisions belong with your clinician, after any finding has been confirmed.

What to do next

Sources

  1. [1]Genetic Testing for Inherited Cancer Risk (fact sheet, reviewed April 18, 2024). National Cancer Institute. Accessed .
  2. [2]Genetic Testing for Hereditary Breast and Ovarian Cancer. Centers for Disease Control and Prevention. Accessed .
  3. [3]Talking to Family About Your BRCA Gene Mutation. Centers for Disease Control and Prevention. Accessed .
  4. [4]Genetic Testing for Lynch Syndrome. Centers for Disease Control and Prevention. Accessed .
  5. [5]BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing (final recommendation, August 20, 2019). U.S. Preventive Services Task Force. Accessed .
  6. [6]Use of SNP chips to detect rare pathogenic variants: retrospective, population based diagnostic evaluation. BMJ, 2021. Accessed .
  7. [7]Clinical significance of large rearrangements in BRCA1 and BRCA2. Cancer, 2012. Accessed .
  8. [8]False-positive results released by direct-to-consumer genetic tests highlight the importance of clinical confirmation testing for appropriate patient care. Genetics in Medicine, 2018. Accessed .
  9. [9]Find a Genetic Counselor. National Society of Genetic Counselors. Accessed .

How we write and source these pieces: our editorial policy.

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NoteSelected variants only, by genotyping. Not a full-gene test.

LabOur genetic tests are laboratory-developed tests performed in our own CLIA-certified laboratory. New York is the exception: orders shipped there are completed through a physician order or a reference laboratory permitted in New York. Our genetic tests have not been cleared or approved by the FDA. Results describe inherited traits and risks and are meant to inform decisions you make with your clinician. They are not a diagnosis.