Author: Amanda Shrewsbury, MS, CGC, Founder of ClearPath Genetics
This guest blog contribution is from Amanda Shrewsbury, MS, CGC, a board-certified genetic counselor and the founder of ClearPath Genetics, a telehealth hereditary cancer genetic counseling and testing practice. Her work centers on hereditary cancer risk assessment, helping people understand what their family history and genetic testing results mean and translating that information into a clear, personalized plan for screening and prevention. She founded ClearPath Genetics to make hereditary cancer care faster and more accessible for families, offering personalized genetic counseling without the long waits and insurance hurdles that often stand between people and the answers they need.
Genetic counseling often sounds like an abstract clinical process to those who have been recommended for it. In reality, though, for people going through genetic counseling, it is one of the more empowering and emotionally significant things they will do for themselves and their families.
As a genetic counselor, I have sat with many people at the start of this process, and the questions they bring are rarely only about genes. They are about what a result might mean for their children, whether they are ready to know, and how they will tell their family. Those questions matter just as much as the science, and a good genetic counseling experience makes room for both.
This article walks through what genetic counseling and testing actually involves, what your results can mean, what happens after you receive them, and the emotional and family considerations that often come along for the ride. Whether you are exploring testing because of a family history of breast or ovarian cancer, or simply want to understand the process, my hope is that this makes the path feel clearer.
What is genetic counseling, and why does it come first?
Genetic counseling often starts with a conversation that happens before any test is ordered. It is where a genetic counselor reviews your personal and family health history, assesses your risk, and helps you decide whether testing makes sense and which test would be most informative. According to the National Cancer Institute, genetic counseling is generally recommended before any genetic testing for inherited cancer risk, and it can be just as valuable afterward, when a result needs interpretation. Counseling first means the testing is purposeful, and that whatever comes back, you have someone to help you make sense of it.
What the process actually looks like
For most people, the process is more straightforward than they expect.
It begins with the pre-test conversation, where the genetic counselor maps out your family history, often across several generations, and talks through what testing can and cannot tell you. This is where you decide, together, whether to proceed. If you move forward, the test itself is simple: a blood or saliva sample with no real physical risk, as Mayo Clinic notes. Modern testing usually looks at a panel of genes rather than a single one.
Then comes the waiting period, usually a few weeks. I mention it because it is often the part people are least prepared for. It can stir up anxiety, and that is completely normal. Finally, the results conversation is where your counselor explains what was found, what it means for you and your family, and where the next steps take shape.
Understanding what your results can mean
Results generally fall into a few categories, each with its own practical and emotional weight:
A positive result means a pathogenic variant (a genetic change known to increase cancer risk) was found. This information tells you your cancer risk is elevated and opens the door to screening and prevention options; it does not mean that you will definitely develop cancer.
A negative result means no such variant was found. When a specific variant is known in your family, and you do not carry it, this is called a true negative, and it can be a genuine relief. A negative result can also bring complicated feelings, including guilt about relatives who did test positive.
A variant of uncertain significance, or VUS, means a genetic change was found, but there is not yet enough evidence to know whether it affects health. This is more common than people expect, and medical decisions are not based on a VUS alone. Most are eventually reclassified, usually as benign.
Beyond BRCA1 and BRCA2
Most people associate hereditary breast and ovarian cancer with the BRCA1 and BRCA2 genes, and for good reason. They are the most well-known genes associated with Hereditary Breast and Ovarian Cancer (HBOC) syndrome. But they are not the whole story. Hereditary risk can involve other genes too, including PALB2, CHEK2, and ATM, and as Cleveland Clinic notes, genetic testing today checks for BRCA1 and BRCA2 along with other known breast cancer genes. This is why modern testing usually looks at a panel of genes, and why the counseling conversation matters for putting any finding in context.
What happens next, after your results
One of the most common questions I hear is simply, “What now?” The answer depends on your result.
After a positive result, the focus shifts to proactive care. This often means enhanced screening, such as breast MRI in addition to mammography, often starting younger and on a more frequent schedule. It may also include conversations about risk-reducing options, from medication to risk-reducing surgery for those who choose it. This is where a dedicated breast care team, like the team at Bedford Breast Center, becomes invaluable, translating a genetic result into a concrete screening and prevention plan and providing surgical expertise when it is wanted. Genetic counseling and testing identify the risk; a skilled clinical team helps you act on it.
After a negative or true negative result, the news is reassuring, but ongoing care still matters. General population screening recommendations still apply, and if your family history is significant, your care team may still recommend additional attention regardless of the genetic result.
After a VUS, your care continues to be guided by your personal and family history rather than by the uncertain variant. Your counselor will also keep your contact information on file so that, if the variant is reclassified down the line, that update can reach you.
The emotional considerations people don’t always expect
Here is the part that the clinical descriptions often leave out. Genetic testing touches something deeper than medical risk. It touches identity, family, and the future.
In my experience, people are often surprised by the weight of the decision itself, the question of whether they even want to know. Some feel relief at finally having answers. Some feel anxiety in the waiting. Some who receive good news feel an unexpected guilt, particularly when a sibling or parent did not. All of these reactions are normal, and none of them are wrong.
What I want people to hear is this: the emotional side of genetic testing is not a complication of the process. It is part of it. Feeling something is not a sign that you are doing this wrong. It is a sign that the information matters.
How genetic testing affects your family
A genetic result is rarely just about one person. Because these variants are inherited, a result can carry meaning for parents, siblings, and children. As FORCE (Facing Our Risk of Cancer Empowered) explains, hereditary cancers affect entire families, and sharing results allows every relative who may be at risk to take steps to protect their health.
This is both a gift and a responsibility, and it can feel like a lot. Deciding whether and how to share results is deeply personal, and families do not always react the same way. A genetic counselor can help you think through these conversations and can often provide a family letter that explains the finding in plain language for relatives to share with their own providers.
A brief note on reproductive considerations
For people of reproductive age, a positive result can become part of family-planning conversations. There are reproductive options worth discussing for those who want to explore them, and a genetic counselor can walk through what is available without pressure in any direction. For many people, this is simply one more piece of information to hold, not a decision that has to be made right away.
Giving yourself permission to go at your own pace
If there is one thing I hope you take from this, it is that there is no single right way or right time to do this. Emotional readiness is important in addition to clinical timing. Some people want to know as soon as possible; others need time to feel ready. Both are valid, but it’s also important to understand the implications of not knowing this information. At its heart, genetic counseling and testing are tools for empowerment, giving you and your family information you can act on, on your own terms.
A gentle next step
Whatever you learn from genetic counseling and testing, you don’t have to navigate it alone. Going at your own pace, with the right support beside you, is exactly how this process is meant to be.
If you would like dedicated genetic counseling support as you think this through, that is exactly what we do at ClearPath Genetics. We offer telehealth hereditary cancer genetic counseling, and we are always happy to be a resource, whether you are just beginning to consider testing or trying to make sense of a result you already have.
Frequently Asked Questions
Do I need genetic counseling before genetic testing? Genetic counseling is generally recommended before testing for inherited cancer risk. It ensures the right test is ordered for your situation and that you understand what the results could mean before you decide to proceed.
Is genetic testing done with blood or saliva? Both are used and are very simple to collect. Your provider will let you know which sample type applies to your test.
How long does it take to get results? Most results come back within a few weeks. The exact timeline depends on the laboratory and the type of test.
Will my insurance cover genetic testing? Coverage varies. When testing meets established medical criteria, it is often covered, and a genetic counselor can help you understand the likely costs for your situation before you proceed.
Should my family get tested if I have a positive result? Often, yes. Close relatives may have inherited the same variant, and a genetic counselor can guide which family members might benefit from testing and in what order.
This article is for educational purposes only and does not constitute medical advice. Always consult your physician, genetic counselor, or other qualified healthcare provider regarding your individual health needs.
Bedford Breast Center is a world-class facility in Beverly Hills dedicated to breast cancer screening and early detection for patients. Our surgeons consider the importance of aesthetics as well as curing disease. We offer state-of-the-art screenings, including mammography and ultrasound, and same-day appointments for urgent issues such as abnormal findings on imaging results. Our top-notch team of physicians and kind, caring staff is here to serve you. Whether you need routine screening, are concerned about breast pain, or face a complicated cancer diagnosis, we stand with you every step of the way.
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