Should counseling before genetic testing for breast cancer be required? This is the debate between insurers and healthcare providers.
What is Genetic Testing?
Genetic testing has become a way of alerting women of their heightened risk for breast cancer. They test for BRCA1 and BRCA2 - two genetic mutations associated with breast and ovarian cancer. Through the analysis of these tests, doctors are able to identify those who are likely to get the disease and be able to discuss preventative measures.
What is Genetic Counseling?
Genetic counseling is the process in which patients at high risk for an inherited disease are advised on the nature of their disorder. Certified Genetic Counselors hold a Master's of Science degree in genetic counseling and are expert educators, as well as highly skilled in translating "medical terms" into more easily understood language. They support patients and their families during the diagnosis and help with treatment options and decision making.
Healthcare Providers vs. Insurers
Healthcare providers believe that counseling should not be required before women have genetic testing done. It has long been a normal practice for obstetrician-gynecologists to counsel women of hereditary cancers and keep track of each individual's medical history. If they know a patient's biological family member had breast cancer, they would be capable enough to inform them of their high-risk for the disease.
Insurers, on the other hand, disagree. Two of which, large national insurers, UnitedHealthcare and Cigna require women to seek genetic counseling by a certified genetic counselor before approving tests. According to Dr. Jeffrey Hankoff, a Cigna official. “We had concerns that people were having testing ordered that didn’t appear to need it and probably didn’t understand it.” Thus, driving up supply and costs for unnecessary tests.
Should counseling before genetic testing be required?
In addition to insurers, genetic counselors believe so. They are the experts - why shouldn't they be the ones to gather the extensive family background information. Some of which may not be covered during routine paperwork. However, with the thriving request for genetic testing, keeping up with the demand could be trying.
In the end, both parties agree that it is of utmost importance to refer any woman with a family history of breast cancer for genetic testing. What they can’t seem to come to an agreement on is the steps leading up to it.