Up until now, if you wanted to learn about how your genes impacted your health, you probably turned to 23andMe. The consumer genetic testing company is the only household name with regulatory clearance to deliver health results straight to customers in the United States. But as of today, Oct. 15, 23andMe is getting competition—of a sort—from the genealogy company Ancestry, which owns AncestryDNA.
AncestryDNA, which launched in 2012, is a genetic testing service that provides customers with an estimated breakdown of their countries of origin. With 15 million users, it’s the largest direct-to-consumer genetic testing company in the world—considerably dwarfing 23andMe’s 10 million customers, who can also get genealogy reports. Now Ancestry’s new service, called AncestryHealth, is making its way into the parallel realm of consumer genetic health tests.
There’s one big difference between AncestryHealth and 23andMe’s health offering: To use the new product, you’ll have to order it through a physician—albeit indirectly. Customers of AncestryHealth will fill out a series of questions about their family health history, much like you would at a doctor’s office. “That information will be going to a physician, who orders the test on your behalf,” says Catherine Ball, Ancestry’s chief science officer. AncestryHealth contracts with PWNHealth, a network of doctors headquartered in New York, to review each order.
Those physicians will advise whether or not a genetic health test is appropriate for a customer. Someone who has had a bone marrow transplant, for example, wouldn’t be a good candidate for any genetic health test—the results would be their donor’s and not their own. And if a customer has a family history of a certain condition, like breast cancer, the physician may recommend that they also visit their primary health care provider in addition to receiving the test results. (If a physician decides it isn’t a good fit, the customer gets their money back.)
Going through a doctor means that Ancestry hasn’t had to jump through the same regulatory hoops as 23andMe. After briefly having its health information services shut down by the US Food and Drug Administration (FDA), 23andMe has gradually received authorization to send certain health results, including health predisposition and carrier status traits, directly to consumers. In order to regain permission to market their tests, 23andMe had to prove that they were accurate, low-risk (in terms of consumers receiving false information), and couldn’t provide a definitive diagnosis—something only medical professionals can do.
Although going through a physician means Ancestry doesn’t provide a true direct-to-consumer genetic health test like 23andMe, the tests will still inform customers if they have certain markers that increase their likelihood of developing a condition. AncestryHealth will look for mutations that lead to increased risk of certain forms of breast cancer, colorectal and uterine cancer, cardiomyopathy, high cholesterol, excess iron in the blood, and excess blood clotting. It will also tell users if they carry recessive genes for sickle-cell anemia, cystic fibrosis, and Tay-Sachs disease, which could be passed down to children.
The goal, Ball says, is to give users information that is clinically actionable—meaning, they can take the results to their health care provider to help guide their care. That’s why AncestryHealth specifically leaves out testing for certain genetic mutations, like a variant of the APOE gene that puts people at a higher risk of developing Alzheimer’s. Because there are no preventative treatments for Alzheimer’s disease, knowing you may be predisposed to developing it may not help your overall health care.
AncestryHealth comes in two forms. AncestryHealth Core analyzes a customer’s genes with a simplified genetic sequencing technique called genotyping; it costs $149 and includes the AncestryDNA analysis (although if you’ve already used AncestryDNA, it’s only $49). As Quartz has reported, genotyping tests only look for a handful of specific mutations that clearly indicate increased risk of a certain condition. As such, they may miss other mutations that could lead to disease, but are still not well-understood.
AncestryHealth Plus, which costs $199, includes next-generation sequencing of all protein-encoding genes in the genome. It’s not a full genome sequence like the ones offered by companies like Veritas Genomics (those still cost closer to $1,000), but it’s more comprehensive than genotyping. Customers receive information about the same conditions, but the lens of next-gen sequencing allows clinicians to look at both known pathogenic mutations and ones that may only be “likely” pathogenic. The Plus option also comes with a six-month membership for $49, so customers can be updated if genetic research illuminates the meaning of a new mutation. Regardless of which test a customer chooses, a physician will deliver the results, and offer genetic counseling resources if necessary.
In addition to genetic testing services, AncestryHealth will allow users to build private family trees that illustrate their health. These trees would only be visible to customers when they log in, but customers can also choose to share anonymized versions of their health information with Ancestry’s research partners. Ancestry currently partners with the USTAR Center for Genetic Discovery, which is part of the University of Utah, and the National Marrow Donor Program. It’s also worked with Calico, the Google-backed aging and longevity startup based in California, in the past, but their partnership has ended. With added health predisposition testing, Ancestry is opening the door for even more research collaborations down the line.
Correction (Oct. 11): An earlier version of this story said Ancestry launched AncestryDNA in 2002. The company launched AncestryDNA in 2012.