Genetic Marker Testing?

Would you support genetic marker testing being paid for by insurance companies?

What if you only wanted insurance companies to pay for it if you could show a family history of breast cancer?

I’ll admit to using language that will undoubtably get some people fired up. On the one hand, anyone who has been through the horror of cancer will likely reply with a resounding YES. On the other hand, it could come across as another case of externalizing your personal costs, something that riles up quite a few people. At the heart of that debate there is a very serious conversation that everyone should engage in. I know why health care costs are out of control. Part of it has to do with a legal system that has drifted too far from its originally intended purpose, but a lot of it has to do with people wanting more… more… more… but without having to pay for it. Now that I think of it, my first point is really just another manifestation of the second.

I digress.

A friend of mine recently sent me an on-line petition via Facebook. The cause I was being asked to support, as you’ve probably surmised by now, is to encourage insurance companies to pay for genetic marker testing when there is even one person in the family who has been diagnosed with breast cancer.

When I debate these types of issues, I like to strip the emotion out and look at the facts. So I went to this organization’s Web site, but found very little (nothing) as to why this would be a good idea, or how they would counter arguments that it is not a good idea. There are some resources there for those impacted by breast cancer and a small blog. Nice site, but the petition itself was mostly an emotional appeal, and there was little else to compel me to sign.

Here’s where this petition fell short, in my estimation.

What happens if you DO have the genetic marker?

I’m gonna go all “six sigma” on you here for a minute. In one study, 8.3% of women with breast cancer were found to have the BRCA1 gene. That, unfortunately, does not tell you whether BRCA1 will give you breast cancer. It doesn’t tell you the odds of you eventually getting breast cancer if you have the BRCA1 gene. That’s a longer study – more expensive and more time consuming – because you’re not studying a known group with breast cancer, you’re studying everyone.

Never mind the fact that your ethnicity plays an incredibly large part in whether or not BRCA1 is an indicator. The 8.3% group is comprised of Ashkenazi Jewish women. If you’re hispanic and have breast cancer, your chances of having the marker is only 1 in 43.

Let me break it down like this for my hispanic friends: You’re more likely to DIE of breast cancer than to HAVE BRCA1.

I’m not against the genetic testing, but I do not think, as a society, we have determined our ethical standards in this area well enough. What if your insurance company approves the test, you get the results back and you have the marker, and then you lose your job (and your health insurance). What happens when you apply for your next job, looking at a stronger likelyhood of breast cancer and expensive treatment? Does your new employer pass the higher cost of your health care on to the rest of your co-workers? Does the company just pick up the slack, in effect doubling the cost of hiring you (never mind the work you’re going to miss while receiving treatment)? Do they let you pick up the additional cost for your health insurance? Remember, BRCA1 does not mean you are guaranteed breast cancer, it just means the odds are worse for you than someone without it.

But you have a family history of breast cancer, so you knew that already.

As of this writing, I do not have a strong opinion about whether or not I would support this test being paid for by my insurance company. It currently costs about $3,000, although once one test is done, it costs much less for siblings or daughters because much of the work is already done. I think if it were my family facing the decision, and we opted to have the test done, we could find a way to come up with the cash. While I have not signed the petition, if you would like to you can find it here.