Genetics is a rapidly growing and changing field. Unquestionably, some people are enjoying the new “direct-to-consumer” versions of genetic testing, finding new relatives or learning more about their family history. Examples of direct-to-consumer test include 23andMe and Ancestry.com.
Genetics is the scientific study of heredity and genes. The question today is, where does science end and commercialism begin? Is 23andMe a scientific study? Which is the correct test for men and women who fall in a high-risk category for breast cancer or prostate cancer?
Since breast cancer strikes both the young and the old, it’s important to know that both private insurance and Medicare will usually cover the costs of genetic testing and counseling when recommended by a qualified physician. A very important question is whether the results of genetic testing can be used to deny health insurance coverage or increase insurance premiums? The answer is no; however, it could impact the ability to get Long Term Care or Life Insurance. No health insurance pays for direct-to-consumer tests. If a genetic counselor assesses genetic risk and recommends counseling, she can coordinate with your physician to order testing. In this case, insurance usually pays. It is prudent to be sure the genetic counselor contacts your insurance company to verify payment.
Genetic counselors are highly educated individuals who map your heredity. Through you, they identify each family member, male or female, who had cancer. In the case of breast cancer, they will look specifically for information on any males or females (parents, siblings, aunts, uncles, cousins) with breast cancer history and any males with a history of prostate cancer. Genetic mutations that we already knew were associated with breast cancer have been shown to be the same mutations that cause an increased risk of prostate cancer.
There is one other option for genetic testing and that is the Mayo Clinic GeneGuide. The Mayo Clinic product tests for specific variants (mutations) that are related to specific diseases. Breast Cancer is NOT on of the variants tested. The diseases for which Mayo’s GeneGuides tests can be found on their website mayo.org.
How do I choose between genetic counseling by a professional plus testing and direct-to-consumer testing? Here are some pros and cons.
Genetic Counseling/Testing with a Professional
||Mayo Clinic GeneGuide
|Identifies thousands of mutations, many in the BRCA1 and BRCA2 genes
||Direct to Consumer testing identifies only 3 mutations associated with BRCA1 and BRCA2
||Test for specific variants (mutations) that are related to specific diseases. Breast cancer is NOT one of the variants tested
|Expensive, but usually paid by insurance or Medicare
||Inexpensive but the entire cost goes to the consumer
||Not covered by most insurance
|In depth counselling regarding the
meaning of the tests
||Pre-and post-testing is available, but a personal physician would be the major point of contact
|Results are safeguarded by general medical privacy (HIPAA) rules
||No privacy guarantee at all. Information could be shared
||Results are safeguarded by general medical privacy (HIPAA) rules
|Requires an order from a physician.
||No order required.
||Healthcare provider determines whether the test is appropriate on an individual basis
In summary, genetic testing is meant to determine whether an individual has inherited a mutation associated with a specific condition such as breast cancer. Although 23andMe has been approved by the FDA for breast cancer screening, their report only reports on 3 mutations of BRCA1 or BRCA2. The only reliable test to date is via a physician order and genetic counseling. GABCC recommends discussing genetic testing with a physician first. If risk for breast cancer is determined to be high, genetic testing should be ordered. Contacting and making an appointment with a genetic counsellor recommended by your physician would come next. Relying on their expert judgement and a primary care physician or specialist, will provide the best outcome for disease prevention.
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