Breast Cancer Testing: 23andMe vs Color
7 Things you should know about Direct-To-Consumer Genetic Testing for Breast Cancer
You saw the commercial, ordered the kit, and spit into a tube. You sent off your DNA to a Direct-to-Consumer genetic testing company like 23andMe.com or Color.com. Now you wait for the results.
Your report arrives. It shows a positive result for BRCA 1 or BRCA 2, two of the most common breast cancer genes where some mutations indicate up to an 80% higher chance than the general population of being diagnosed with breast cancer before you reach 80 years of age. Now what? Are your results accurate? Will you pass the breast cancer genes to your children?
Before you panic, it’s worth understanding what these two genetic testing firms offer in the fight against breast cancer.
Genetic testing is a complex area that requires not only DNA data but insightful counseling to help you understand your risks, options, and next steps. The expansion of the consumer oriented genetic testing market includes several players. 23andMe.com and Color.com in particular have both staked claim to expertise evaluating genetic risks associated with breast cancer. These companies provide simple, at-home, genetic testing kits that can provide some understanding of your breast cancer risks.
These DNA tests are useful, but do not provide comprehensive medical results. Here are 7 things you should know before purchasing a consumer DNA genetic testing kit to understand your breast cancer risk.
1. Direct-to-consumer or physician ordered.
23andMe is licensed by the Federal Drug Administration to sell genetic testing services directly to consumers. They sell their kits through a variety of retails partners and online from their website and Amazon. 23andMe is thus allowed to bypass the traditional medical requirement of physician ordered lab tests with this FDA approval.
Conversely, Color.com is physician ordered. They work with your own physician or you can request one of Color’s partner physicians to order the test on your behalf. You can only order the test from Color’s website or through your physician. If you use Color’s physician, they will then in turn review results and refer you to follow up testing or genetic counseling if your results indicate concerns.
2. Understand which Breast Cancer Gene Mutations are tested –
Mutations on the BRCA1 and BRCA2 genes are known to be associated with higher risk for prostate cancer, ovarian cancer, and breast cancer. 23andMe reportedly tests for just three mutations on these genes. The three mutations tested by 23andMe are the most common for those of Ashkenazi Jewish descent. These three mutations however are not the most common mutations in the general population.
For breast cancer risk assessment, Color’s BRCA Test is considered more comprehensive because it includes sequencing analysis of the entire BRCA1 and BRCA2. There are over 5,000 genetic changes, the so called mutations or variants, identified in the BRCA1 and BRCA2 genes.
If breast cancer is your primary concern, we feel it’s important to ensure that the test you choose covers as many of the possible mutations that have medical evidence linking them to elevated cancer risk. According to Breastcancer.org, there are additional genes, including PALB2, CHEK2, and PTEN, which are critical in identifying breast, ovarian, and prostate cancer. Color’s more expansive Hereditary Cancer Test analyzes these additional genes in addition to BRCA 1 & 2.
3. Consider Genetic Counseling
Color.com offers access to genetic counseling and works closely with your physician to approve breast cancer genetic testing and develop a care plan. However, 23andMe.com only provides a link to the National Society of Genetic Counselors website, where you’ll have to find your own counselor. Mary Freivogel, President of that society, recently wrote about her concerns over such testing. “Direct-to-consumer genetic testing is an exciting option…but genetic test results are empowering only if they are interpreted correctly.”
4. Know What You’re Paying For
The Health and Ancestry Test from 23andMe.com is currently priced at $199 and includes ancestry, health, carrier, and wellness reports.
Color's BRCA Test is regularly priced at $149.00 includes access to genetic counselors, and health management tools to share with your provider and family. If your physician orders the test, it may be covered under your health insurance. But as Breastcancer.org advised, be careful. Your insurance may only pay for genetic testing once in your lifetime.
Both companies regularly offer discounts and sales for online kit orders. So be sure to check CompendiumDx.com/Shop for the latest pricing and offers from either company.
5. Testing vs. Reports
Color.com tests for BRCA 1 and BRCA 2 and shares those results with your doctor or genetic counselor. 23andMe.com also tests for these two breast cancer genes, but recently received FDA approval to offer the BRCA1/BRCA2 (Selected Variants) Report. They are adding this breast cancer report to their portfolio of over 70 reports that address your ancestry, genetic health, wellness, and carrier traits.
6. Testing Technology
There are different DNA test technologies in use today. The two main version of genetic sequencing are next generation sequencing (NGS) and single nucleotide polymorphism array (SNP). Color uses advanced NGS technology. The FDA considers it to be the next chapter in genetic testing. 23andMe at one point had been working on adapting their service to next gen technology, but in August of 2016 they reportedly let go most of its scientists who were working on next-generation sequencing. As such, current DNA testing by 23andme utilizes the single nucleotide polymorphism DNA array technique.
7. Understand the Limits of the Tests
According Genome.gov there are over 21,000 genes that have been identified. Color.com tests for a total of 30 genes and 23andMe.com tests for over 40 genes – a small fraction of all the genes we carry. Breastcancer.org indicated that there are 14 other genes that are linked to breast cancer. While BRCA1 and BRCA2 are the most common causes of hereditary breast and ovarian cancer, you may want to consider broader testing that includes additional genes. Color’s Hereditary Cancer Test analyzes 30 genes where mutations are known to increase your risk of hereditary breast, colorectal, ovarian and even prostate cancers.
When comparing the genetic testing services of 23andMe versus Color, it is important to consider what you are testing for and the specific information you are hoping to learn. Should you spend $200 - $350 on a direct-to-consumer genetic test for breast cancer? As long as you understand the risks and limitations, many customers feel that knowledge is power. Where Color.com is more specific and partners with doctors and counselors, 23andMe.com offers a wider range of genetic disease reports. If your DNA reports provide an early warning that you - and your children - are susceptible to breast cancer or other genetic issues, it may be the best investment you ever made.