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The Need to Improve the Clinical Utility of Direct-to-Consumer Genetic Tests: Either Too Narrow or Too Broad.

Direct-to-consumer (DTC) genetic testing for disease susceptibility is largely dominated by 2 extremes— narrow tests that only screen for a few variants and broad tests that include dozens of genes. These tests may lack clinical utility for consumers wanting to understand their disease risks. In the context of genetic testing, clinical utility refers to the ability of a test to generate results that can be used to reduce morbidity and mortality through the adoption of medical management strategies, including screening and surgery. Narrow and broad tests, however, lack clinical utility for different reasons. Narrow tests are often incomplete, and only include a limited number of relevant variants.1 Broad tests, by contrast, are concerning because they often include genes for which well-established risk estimates, medical management guidelines, or both may be absent.