title: Internet-Based Direct-to-Consumer Genetic Testing: A Systematic Review.
abstract: BACKGROUND
  Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval of genetic information outside the clinical context. There is a broad debate about the testing validity, their impact on individuals, and what people know and perceive about them.
  
  
  OBJECTIVE
  The aim of this review was to collect evidence on DTC-GT from a comprehensive perspective that unravels the complexity of the phenomenon.
  
  
  METHODS
  A systematic search was carried out through PubMed, Web of Knowledge, and Embase, in addition to Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist with the key term "Direct-to-consumer genetic test."
  
  
  RESULTS
  In the final sample, 118 articles were identified. Articles were summarized in five categories according to their focus on (1) knowledge of, attitude toward use of, and perception of DTC-GT (n=37), (2) the impact of genetic risk information on users (n=37), (3) the opinion of health professionals (n=20), (4) the content of websites selling DTC-GT (n=16), and (5) the scientific evidence and clinical utility of the tests (n=14). Most of the articles analyzed the attitude, knowledge, and perception of DTC-GT, highlighting an interest in using DTC-GT, along with the need for a health care professional to help interpret the results. The articles investigating the content analysis of the websites selling these tests are in agreement that the information provided by the companies about genetic testing is not completely comprehensive for the consumer. Given that risk information can modify consumers' health behavior, there are surprisingly few studies carried out on actual consumers and they do not confirm the overall concerns on the possible impact of DTC-GT. Data from studies that investigate the quality of the tests offered confirm that they are not informative, have little predictive power, and do not measure genetic risk appropriately.
  
  
  CONCLUSIONS
  The impact of DTC-GT on consumers' health perceptions and behaviors is an emerging concern. However, negative effects on consumers or health benefits have yet to be observed. Nevertheless, since the online market of DTC-GT is expected to grow, it is important to remain aware of a possible impact.
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy, Brescia, Italy. loredana.covolo@unibs.it.
authors.forename: Loredana
authors.identifier: http://orcid.org/0000-0002-9057-1629
authors.initials: L
authors.lastname: Covolo
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0003-1086-8914
authors.initials: S
authors.lastname: Rubinelli
authors.forename: Elisabetta
authors.identifier: http://orcid.org/0000-0002-4856-5364
authors.initials: E
authors.lastname: Ceretti
authors.forename: Umberto
authors.identifier: http://orcid.org/0000-0001-7888-5716
authors.initials: U
authors.lastname: Gelatti
mesh_terms: D000328:Adult; D000067108:Direct-To-Consumer Screening and Testing / Q000379:methods*; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male
keywords: Internet; direct-to-consumer; genetic testing; online market; systematic review