What your genes sayand what follows from it.

The difference lies in method, scope and interpretation. Consumer tests usually rely on genotyping arrays: they check a few hundred thousand pre-selected positions and only find what the chip looks for. We sequence instead, using whole exome sequencing for the protein-coding regions and whole genome sequencing for the entire genome, and evaluate more than 170 clinically relevant risk genes. This makes rare variants visible that an array fundamentally cannot capture. The second difference is legal: in Germany, predictive genetic testing is a medical service governed by the Genetic Diagnostics Act. You receive findings and counselling from a physician, not a PDF full of percentages.

For predictive testing, yes, and it is mandatory. The German Genetic Diagnostics Act permits predictive genetic testing only when ordered by a physician, and §10 requires genetic counselling both before the test and once the result is available. This is not a formality: with BRCA1/2 or ApoE4, the counselling determines whether the result is usable for you at all. It also covers your right not to know, which you can exercise at any time, including after the blood draw and for individual categories of findings. Before sequencing we establish in writing which categories of results you want to be told about and which you do not.

Pathogenic variants in BRCA1 or BRCA2 substantially raise the risk of breast and ovarian cancer, for breast cancer to roughly 60 to 70 percent cumulatively by age 80. The decisive point is that concrete consequences follow: intensified surveillance with MRI from a considerably younger age, the option of risk-reducing surgery and, in the event of disease, relevance for treatment selection. Testing is particularly warranted with a family history, meaning breast or ovarian cancer in close relatives, early age at onset or male breast cancer in the family. Without a family history the predictive value is lower, but a finding remains actionable. Counselling under the Genetic Diagnostics Act clarifies whether the test makes sense in your situation.

That is a question to answer before the test, not after. ApoE4 is the strongest known genetic risk factor for late-onset Alzheimer’s disease: one copy raises risk roughly two to threefold, two copies considerably more. But ApoE4 is neither necessary nor sufficient: many carriers never develop the disease, and many patients carry no E4. There is no established therapy that lowers the risk. What has made the status clinically relevant is the new class of amyloid antibodies: ApoE4 homozygotes carry a markedly higher risk of ARIA, meaning treatment-associated brain oedema and microhaemorrhage. Anyone considering such a therapy needs the status. Anyone wanting it out of curiosity should honestly account for the psychological burden.

Familial hypercholesterolaemia. Variants in LDLR, APOB or PCSK9 cause markedly elevated LDL cholesterol from birth and therefore substantially advanced cardiovascular risk. It affects roughly one in 250 people, making it more common than most inherited conditions, and it remains largely undiagnosed. That is precisely what makes it the most interesting finding from sequencing: it is common, it responds very well to statins and PCSK9 inhibitors, and the earlier treatment starts the greater the benefit gained. A high LDL in the lab is the first clue; genetic confirmation establishes whether this is a lifelong burden or an acquired shift.

Pharmacogenetics is the part of genetics with the clearest and most immediate benefit, because international dosing guidelines exist for the most important gene-drug pairs, for instance from CPIC. Practical examples: CYP2C19 determines whether clopidogrel works for you at all. SLCO1B1 says something about your risk of muscle symptoms on statins. DPYD and TPMT are safety-relevant before certain chemotherapies, because a variant can trigger severe toxicity. CYP2D6 affects numerous antidepressants and analgesics. The finding is obtained once and remains valid for life. It benefits you above all when you have it to hand at the point of treatment, which is why you receive it in a shareable format.

Considerably less reliable than the market suggests, and we say so plainly. These variants are linked via association studies to traits such as stress reactivity, caffeine metabolism or homocysteine metabolism. The effect of any single variant is usually small and heavily context-dependent. With MTHFR the picture is especially clear: the American College of Medical Genetics explicitly recommends against testing, because no dependable clinical consequences can be derived from it. The more informative route is the reverse: we measure homocysteine, folate and B12 directly in blood. If those values are abnormal, we act, regardless of genotype. At YEARS, lifestyle genetics is interesting context, not a basis for recommendations.

It is part of YEARS Ultimate from 16,900 euros and is not sold as a standalone service. Ultimate includes more than 230 biomarkers, whole-body MRI, liquid biopsy, microbiome analysis, epigenetic clocks, neurological diagnostics and a dedicated health manager across the year. That is a deliberate decision: a genetic finding without laboratory work, imaging and longitudinal medical follow-up beside it is not, in our view, a service worth selling, because its consequences only emerge in context. If you want to answer one specific question, such as a known BRCA variant in your family, a clinical genetics centre is the more appropriate and cheaper route. With a documented family history, statutory insurance coverage is also possible there.