You can get genetic testing for cancer risk through several channels: a cancer center or hospital genetics department, your oncologist’s office, a standalone genetic counseling service, or a telehealth genetics company. The best starting point for most people is a board-certified genetic counselor, who can help determine which test is appropriate and order it through a clinical-grade laboratory. Out-of-pocket costs for a multi-gene cancer panel typically run around $250 at self-pay rates, and many people qualify for free or insurance-covered testing.
Cancer Centers and Hospital Genetics Programs
Most major medical centers and cancer hospitals have dedicated genetics departments staffed by genetic counselors, medical geneticists, and oncologists who work together to assess your risk. These teams evaluate your personal and family cancer history, recommend the right test panel, walk you through results, and connect you with specialists if needed. Some programs also include referrals to mental health professionals or reproductive specialists when results raise those concerns.
NCI-designated cancer centers (there are 72 across the United States) generally offer the most comprehensive genetic risk assessment services. But you don’t need to go to a specialty cancer center. Community hospitals, university medical systems, and many OB-GYN or oncology clinics now have genetic counselors embedded in their practices. Some oncologists handle pretest education, consent, and ordering themselves, then refer patients with positive or complex results to a genetic counselor for detailed follow-up.
How to Find a Genetic Counselor
The National Society of Genetic Counselors maintains a searchable directory at findageneticcounselor.nsgc.org with over 3,300 counselors in the U.S. and Canada. You can filter by location for in-person visits or search the telehealth directory for counselors who meet with patients by phone or video. Telehealth genetic counseling has expanded significantly, making it possible to access a qualified counselor even in areas without a local genetics program.
A genetic counselor does more than just order a test. They review your family tree for patterns that suggest a hereditary cancer syndrome, help you understand what a positive, negative, or uncertain result would actually mean for you, and create a follow-up plan. If testing isn’t warranted based on your history, a good counselor will tell you that too.
Inherited Testing vs. Tumor Testing
When people search for cancer genetic testing, they’re usually thinking about inherited (germline) testing, which uses a blood or saliva sample to check whether you carry gene variants passed down through your family. This is the type of testing that tells you and your relatives about cancer risk before a diagnosis, or helps explain why cancer runs in your family.
Tumor (somatic) testing is a different process. It analyzes DNA from a cancer that’s already been diagnosed, looking for mutations that developed in the tumor itself and could guide treatment decisions. A study from UW Health found that these two types of testing identify different variants and can’t be used interchangeably. If your oncologist ordered tumor profiling, that doesn’t replace inherited genetic testing, and vice versa. If you have a cancer diagnosis, ask whether both types have been considered.
Why Direct-to-Consumer Tests Fall Short
Companies like 23andMe offer a consumer-level report on certain cancer-related gene variants, but the scope is extremely limited. The FDA-authorized 23andMe BRCA report checks for only three specific variants out of more than 1,000 BRCA1 and BRCA2 variants known to increase cancer risk. Those three variants are most common in people of Ashkenazi Jewish descent and are rare in other populations. A negative result from a consumer test does not mean you don’t carry a harmful BRCA variant.
Clinical-grade testing ordered through a genetic counselor or physician screens far more comprehensively. Multi-gene panels can evaluate dozens of genes linked to breast, ovarian, colon, pancreatic, prostate, and other cancers in a single test. If you’ve only done a consumer test and have a significant family history of cancer, clinical testing is worth pursuing.
Who Qualifies for Testing
National guidelines from the NCCN outline specific criteria for when genetic testing is recommended. Common triggers include a personal history of cancer diagnosed at an unusually young age, multiple cancers in one person, a pattern of related cancers across your family (breast and ovarian, for example, or colon and uterine), or a known genetic variant already identified in a relative. Certain cancer types, like triple-negative breast cancer diagnosed before age 60 or epithelial ovarian cancer at any age, are strong indicators on their own.
You don’t necessarily need a cancer diagnosis to qualify. If a close family member tested positive for a hereditary cancer gene, testing you for that specific variant is one of the most straightforward and valuable uses of genetic testing. A genetic counselor can assess whether your personal and family history meets current guideline criteria.
What Testing Costs and How Insurance Works
Many clinical labs offer a self-pay rate of around $250 for a multi-gene cancer panel, regardless of insurance status. Some people qualify for free testing through lab-sponsored programs, institutional financial assistance, or research studies.
Insurance coverage, including Medicare, generally requires that the testing be medically appropriate based on your personal and family history. For Medicare specifically, coverage of BRCA testing requires a pattern consistent with hereditary breast and ovarian cancer syndrome: multiple related cancers in a family, cancer at an earlier-than-typical age, or more than one primary cancer in the same person. The genes included on the panel need to be relevant to your specific history. Private insurers follow similar logic, though exact policies vary. Your genetic counselor’s office typically handles prior authorization and can tell you in advance what your out-of-pocket cost will be.
Legal Protections for Your Results
A federal law called the Genetic Information Nondiscrimination Act (GINA) provides two key protections. Title I prevents health insurers from using your genetic test results to deny coverage or raise premiums. Title II makes it illegal for employers to use genetic information in hiring, firing, promotion, or any other employment decision. Employers are also restricted from requesting or requiring genetic information in the first place.
GINA’s definition of genetic information is broad. It covers your own test results, your family members’ results, your family medical history, and even your participation in genetic research. That said, GINA has known gaps: it does not apply to life insurance, disability insurance, or long-term care insurance. If you’re considering purchasing any of those policies, it may be worth having them in place before genetic testing, since those insurers can legally ask about and use genetic test results.