Background. Inherited BRCA gene mutations convey a high risk for breast and 
ovarian cancer, but current guidelines limit BRCA mutation testing to women with 
early-onset cancer and relatives of mutation-positive cases. Benefits and risks 
of providing this information directly to consumers are unknown. Methods. To 
assess and quantify emotional and behavioral reactions of consumers to their 
23andMe Personal Genome Service(®) report of three BRCA mutations that are 
common in Ashkenazi Jews, we invited all 136 BRCA1 and BRCA2 mutation-positive 
individuals in the 23andMe customer database who had chosen to view their BRCA 
reports to participate in this IRB-approved study. We also invited 160 
mutation-negative customers who were matched for age, sex and ancestry. 
Semi-structured phone interviews were completed for 32 mutation carriers, 16 
women and 16 men, and 31 non-carriers. Questions addressed personal and family 
history of cancer, decision and timing of viewing the BRCA report, recollection 
of the result, emotional responses, perception of personal cancer risk, 
information sharing, and actions taken or planned. Results. Eleven women and 14 
men had received the unexpected result that they are carriers of a BRCA1 
185delAG or 5382insC, or BRCA2 6174delT mutation. None of them reported extreme 
anxiety and four experienced moderate anxiety that was transitory. Remarkably, 
five women and six men described their response as neutral. Most carrier women 
sought medical advice and four underwent risk-reducing procedures after 
confirmatory mutation testing. Male carriers realized that their test results 
implied genetic risk for female relatives, and several of them felt considerably 
burdened by this fact. Sharing mutation information with family members led to 
screening of at least 30 relatives and identification of 13 additional carriers. 
Non-carriers did not report inappropriate actions, such as foregoing cancer 
screening. All but one of the 32 mutation-positive participants appreciated 
learning their BRCA mutation status. Conclusions. Direct access to BRCA mutation 
tests, considered a model for high-risk actionable genetic tests of proven 
clinical utility, provided clear benefits to participants. The unexpected 
information demonstrated a cascade effect as relatives of newly identified 
carriers also sought testing and more mutation carriers were identified. Given 
the absence of evidence for serious emotional distress or inappropriate actions 
in this subset of mutation-positive customers who agreed to be interviewed for 
this study, broader screening of Ashkenazi Jewish women for these three BRCA 
mutations should be considered.