Genetic tests for cancer

Companies that profit from the overzealous use of unnecessary screening tests:

Critics say that advertising such a complex screening test to the general population might create unnecessary anxiety among women and lead to overuse of the test, which costs $3,120.
“It really preys on the fears of our society, and one of those fears is getting breast cancer,” said Ellen T. Matloff, director of cancer genetic counseling at the Yale Cancer Center.

Comments

Anonymous
More “let’s disempower people and keep our professional prerogatives” from Kevin. Big surprise, there!
If people want to examine their predisposition to certain cancers, what’s wrong with that? It may produce “anxiety” but it may also induce healthy habit changing. I.e., learning you have a predisposition towards certain types of cancer may be the needed impetus to quit smoking.
The notion that it is “unnecessary” is bizarre. Yes, for most people the probability of some positive result is next to nothing. But, if they feel the information might be valuable, why not?
Anonymous
The notion that it is “unnecessary” is bizarre.
Is it? Say a test produces an incorrectly positive result or is incorrectly interpreted. A scared woman thinking her risk is in double digits may decide to remove her ovaries as a result. Not only there is a risk associated with an operation, such a woman would increase her risk of having heart desease, osteoporosis, higher chance of death (all-cause mortality is higher in women who lost their ovaries early), not to mention quality of life. She may go on HRT to counteract some of these risks, but it may have its own risks.
Even if you say this possibiliy is small, say 1%, multiply this by the number of women taking the test and you’ll get a lot of women.
In addition, there is a little issue of cost. As long as you are paying out of pocket you can do whatever you feel like. But if someone else is paying out of a limited pool, maybe the money should go to where they do most use, like, I don’t know, necessary testing or a life-saving treatment?
Anonymous
Never let logic get in the way of a good doctor bashing, I always say.
You know, these doctors must be making a FORTUNE by keeping these things from people. Otherwise, why not go ahead and do the test, right?
Anonymous
“A scared woman thinking her risk is in double digits may decide to remove her ovaries as a result”
Besides the sexism in figuring the scared patient as a woman, your comment, anon, is bizarre. Ummm, how will she remove her ovaries, with a kitchen knife and a mirror? Of course not, a DOCTOR will. If doctors cannot explain reasonable risks to patients, doctors should not be practicing. Further, one would hope that, before such a drastic procedure were done, a doctor would seek additional consultation or a second test. That’s prudence. Again, if doctors are not prudent, they shouldn’t be practicing.
And, these tests ARE out-of-pocket, as most medical expenses should be, especially those, like genetic testing, the utility of which is related to each individual’s risk aversion.
Mike
anon 9:14
sexism??? The article is about breast cancer.
Anonymous
We have someone who doesn’t know what they are talking about in our midst. The article refers to breast cancer. This is MUCH more common in women (although very deadly in men too when it occurs due to the rarity). I can’t remember which BRCA it is, but there is also an increased risk of ovarian cancer with the breast cancer. So let’s say it is a false positive. I can see this leading to some very big problems. And just double checking by doing the same test won’t alleviate these problems.
MedFriendly
To properly judge the adequacy of this screening tests, we need to know a few basic statistics about it:
1) Sensitivity: the % of cases in which the test produces a positive result in people with breast cancer.
2) Sensitivity: the percent of cases in which the test produces a negative result in patients without cancer.
3)Positive predictive value: the probability that someone with a positive test result actually has breast cancer
4) Negative predictive value: the probability that someone with a negative test result does not have breast cancer.
Dominic A. Carone, Ph.D.
Founder and Webmaster of MedFriendly.com and The MedFriendly blog.
Anonymous
Mike, I truly hope you are not a doctor. Men get breast cancer too.
Alla
Anon at 12:55 – the breast cancer is much rarer in men, so consequently the probability is significantly lower than men would get genetic testing for breast cancer. Also, the example of ovaries is the most obvious one of unintended harm that came to mind. At least to me, given that I am a woman. I am sure doctors could find examples for men as well. It is utterly ridiculoous to bring up sexism because an example of unintended harm featured a woman.
medfriendly – another important criteria of screening tests is whether or not they actually decrease mortality from the desease.
I was the anon at 3:55 – clicking anonymous is quicker.
Mike
anon 12:55
If you are going to honestly sit there with a straight face and argue that male breast cancer is the issue alluded to, and that BRCA testing concerns mostly male patients, then you are just a complete and utter waste. Yes. lots of men worry about losing a breast. You’re a joke.
But I know you’ll never admit the stupidity of yoursexism remark. You can’t win that one dear. And I’d love to see how youremove male ovaries. Let me know.
Anonymous
Mike,
I am anon 12:55
My father died of breast cancer because his physician ignoring his lump told him “men don’t get breast cancer”.
I never said you were sexist. If anything I’d say you’re ignorant. If you really are a doctor, do your patients a favor and retire.
Anonymous
Very unfortunate 12:55. I think that makes you miss the forest (big picture) from the tree (your father). I don’t know of any evidence of the BRCA gene and male breast cancer. Please provide links if I am wrong.
Anonymous
BRCA 1 is not clearly associated with an increased risk of male breast cancer though BRCA 2 is associated. But let’s be honest here, male breast cancer IS a rare entity with about 1,000-1,500 cases per year diagnosed. The bigger issue here is that BRCA testing should probably only be ordered by an oncologist trained in inherited malignancy syndromes (that would not be all oncologist’s by the way) in conjunction with genetic counseling. There needs to be a complete review of a family pedigree by a professional who can clearly document the risk of breast cancer occurance and the possible association of an inherited malignancy syndrome (we aren’t just talking breast cancer here guys). Frankly most docs aren’t qualified to do a good job of risk assessing the need for testing in thise setting let alone the lay public. But it is not about evidence-based medicine here, it is about Myriad making some $$$ on the fears of getting cancer. Disgusting.
Anonymous
This is anon 12:55 (again);
I just wanted to say I’m sorry for my initial responses, and apologize to Mike that (I think) unfairly and somewhat caustically went after him.
In retrospect I over-reacted. I’m not a doctor…but i do get the gist of what people are saying about limitations of BRCA screening…particularly as it applies to men.
Anyways, thanks to you all with clearer heads than mine.

Genetic tests for cancer

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