Wednesday, September 10, 2014

A bit of overkill?

When is it a bit too much??? There is a new study out (of course another study - just what we needed) where the author calls for across the board BRCA testing. Yes really. Go read it here. And you can read what Dr Love thinks about this here.

My thoughts are now I know why people want to live off the grid without government interference. This really goes a bit too far.

I know breast cancer is a bad thing. The BRCA genes are responsible for somewhere around 25-30% of all hereditary breast and ovarian cancers and 5-10% of all breast cancers. So of the 250,000 or so breast cancer diagnoses each year in the US, this might lead to detecting 12,500-25,000 cases of breast cancer early.

I honestly don't see the benefit of testing millions of Americans to 25,000 cases annually. I know the cases add up and each person gets tested once so its not that clear but I do not see the cost/benefit ratio here. As Dr Love points out, who is going to pay for all this? The Affordable Care Act would probably want the insurance companies to pick up the tab - and you know the cost of that test is going to hit your premiums somewhere/somehow. And since men can carry the BRCA gene and get breast cancer, they would need to be tested as well.

And if you test positive for the gene you can take preventative measures such as tamoxifen and mastectomies but there is no guarantee you can prevent yourself from getting cancer. You can only reduce your risk.

I think the current system of looking at family history and then making educated decisions on a one-on-one basis with each person's doctor is better. Because if you look at the numbers the other way, 90-95% of the cases of breast cancer diagnosed each year are not due to the BRCA gene.

Before we go for across the board testing for anything, we need to look at the incidence of the disease being screened and the cost benefit ration. Breast cancer isn't contagious as so many think.

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