Last month, the Food and Drug Administration authorized genetic-testing company 23andMe to provide the first ever direct-to-consumer genetic test for cancer risk. The test screens for three types of mutations on the BRCA-1 and BRCA-2 genes, which are two genes found to be associated with risk for ovarian and breast cancer.
23andMe’s $199 test kit allows people to mail in a saliva sample to be tested for mutations. Although the test is simple and inexpensive, the Sarah Lawrence College genetic counselor specifies, “[The test] is not an inexpensive way to get your testing done more cheaply.” Rather, it is meant to provide some information about your risk of developing cancer, in the same way risk questionnaires assess risk based on some basic information about family history and lifestyle choices.
23andMe makes this clear, specifying a positive test result can mean a 45 to 85 percent chance of developing breast cancer, which is quite a large range that ultimately doesn’t really stipulate anything certain.
A negative test result also doesn’t really mean anything either, which 23andMe has been clear about. In the past, they have emphasized, “most cases of cancer are not caused by the genetic variants in this report. A person could have a variant not included in this test, or could develop cancer for other reasons.”
With neither result providing particularly definitive answers, the purpose of this test is really to give women a clearer picture of their potential for developing cancer that ideally will provide a starting point off of which to base future, more concrete tests with a doctor or genetic counselor.
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Critics of the test have lambasted its potential propensity for leading women to take drastic, unnecessary steps based on the results. Shelley Luedtke, of Sun Prairie, Wisconsin, was diagnosed with the BRCA-1 gene 15 years ago. Her doctor prescribed a relatively extreme treatment plan, which included a necessary hysterectomy, but her fear about this test is people may jump immediately to that solution.
“People get a test result and then immediately want to fix it,” Luedtke said. “If I wouldn’t have had a genetic counselor to talk to about what do I do now, I don’t know where I would’ve gone.”
UW Health Carbone Cancer Center physician Dr. Lisa Barroilhet emphasized the importance of discussing the test results with a doctor and undergoing further, more extensive test results before taking any drastic steps.
“If you’re a patient who gets a 23andMe test that comes back positive, you then have to go to your physician and have them repeat the test by a certified laboratory to make sure it’s in fact correct,” Barroilhet said.
Despite its shortcomings, however, this test is an incredible medical and technological advancement that allows women to have a greater understanding of their health and health risks — something this country is dangerously lacking.
But what does the necessity of tests like this say about the accessibility of legitimate, comprehensive healthcare for women? Why is it not this easy to get a simple screening from a primary care physician’s office?
Under former President Barack Obama’s flagship Affordable Care Act, Medicare and most private health insurance companies were required to cover the entire cost of cancer screenings. This stipulation led to a 5.5 percent increase in the number of women on Medicare seeking mammograms, a particular type of screening for breast cancer.
But accessibility for such tests is under attack at the hands of President Donald Trump and his American Healthcare Act. While the AHCA maintains the requirement for private health insurance plans to cover preventative cancer screenings, it repeals the requirement for Medicaid to cover such screenings.
Brown University associate professor of medicine Dr. Amal Trivedi expressed his concern AHCA will reverse the Obama-era progress.
“If the cost-sharing provisions are repealed and health plans reinstate copayments for screening mammograms, fewer older women will receive recommended breast cancer screening,” Trivedi said. “That could harm public health.”
The Trump administration’s plan to defund Planned Parenthood is yet another assault on women’s healthcare that has led to the necessity of the 23andMe test.
According to their 2016-17 annual report, Planned Parenthood provided 660,777 tests related to cancer screening and prevention last year. For 75,040 women, Planned Parenthood managed to detect cancer early, and that figure doesn’t even include the number of women who received accurate information about cancer risk. Defunding Planned Parenthood would inevitably lead to decreased ability to perform these tests which would, again, harm public health.
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The 23andMe test, which gives women an opportunity to have a greater understanding of their health, is an impressive step forward. But at the end of the day, this shouldn’t really be necessary, and its existence brings our country’s shortcomings in terms of women’s healthcare into the limelight. These same shortcomings come to light in other, more objectively detrimental ways.
Take crisis pregnancy centers as another example. These centers bask under the guise of providing women with comprehensive information about pregnancy, parenthood and choices for pregnant women. Many centers even have the word “choice” in the name.
In reality, these center are abrasive, often religiously-affiliated, clinics which dish out false information about the efficacy of birth control and the dangers of abortion. These centers essentially guilt women into carrying pregnancies to term they may not be able to, but also fail to provide sufficient resources for women while pregnant and for mother and baby once the child is born.
Crisis pregnancy centers exist in the thousands because places like Planned Parenthood, which actually provide comprehensive healthcare, are in endangered numbers. The U.S. has more than 3,000 crisis pregnancy centers, while there are only around 650 Planned Parenthood clinics in the country. These centers are able to take advantage of the inaccessibility of women’s healthcare and exploit women to push their own anti-women agendas.
Women need complete healthcare. That’s just a simple fact. If the government is not going to provide appropriate access, then women have to resort to second-tier, incomplete resources, which is often dangerous. Women deserve better than incomplete healthcare. Women deserve comprehensive, easily accessible, easily affordable, government-sponsored healthcare. When that is lacking, women’s health is at even greater risk.
Cait Gibbons ([email protected]) is a sophomore majoring in math with a certificate in Chinese.