Last week, the New York Times published the article, “A Genetic Test That Very Few Need, Marketed to the Masses,” reporting on a direct-to-consumer advertising campaign by Myriad Genetics.
Myriad is pushing its “BRACAnalysis” genetic test in these ads, which costs $3,120 according to the news report, and is described online as “A genetic test for hereditary breast and ovarian cancer.”
BRACAnalysis isn’t truly a test for breast and ovarian cancer, however, but a test for mutations in the BRCA1 and BRCA2 genes that are believed to be associated with some cases of breast and ovarian cancer. Your genes, however, are not the only factor in determining your cancer risk. Furthermore, these mutations are estimated to be related to only about 10 percent of breast cancer cases, and it is estimated that only about 2 percent of women have family risk factors that would suggest that genetic testing might be worthwhile.
In other words, the vast majority of women who will see these commercials would not benefit from obtaining this test. While a doctor would still have to be consulted for a patient to receive the test, that is not a guarantee of appropriate use of the testing or adequate counseling of patients about their options.
Myriad previously conducted a similar campaign in other markets in 2002-2003, which resulted in providers reporting being asked more frequently about the tests and ordering them more often, despite acknowledging that they lacked sufficient information to counsel patients about inherited breast and ovarian cancers and testing.
Even when increased family risk suggests that genetic testing might be warranted, women who find that they have a BRCA1 or BRCA2 mutation have surprisingly few options for preventing future cancer. In a recommendation statement on genetic testing for breast and ovarian cancers, the U.S. Preventive Services Task Force states:
Among women with BRCA1 or BRCA2 mutations, prophylactic mastectomy or oophorectomy decreases the incidence of breast and ovarian cancer; there is inadequate evidence for mortality benefits. Chemoprevention with selective estrogen receptor modulators may decrease incidence of estrogen receptor-positive breast cancer; however, it is also associated with adverse effects, such as pulmonary embolism, deep venous thrombosis, and endometrial cancer. Most breast cancer associated with BRCA1 mutations is estrogen receptor-negative and thus is not prevented by tamoxifen. Intensive screening with mammography has poor sensitivity, and there is no evidence of benefit of intensive screening for women with BRCA1 or BRCA2 gene mutations. Magnetic resonance imaging (MRI) may detect more cases of cancer, but the effect on mortality is not clear.
What does that mean in plain language? If you have one of these genetic mutations, you could choose to have your breasts or ovaries removed now, even though the evidence is limited that this would decrease your risk of death. You could up your frequency of cancer screening, but that may not detect every case of cancer or affect your lifespan. You could choose to take certain drugs, but the effects of the drugs themselves may be life-threatening.
What is the purpose, then, of so many women being targeted by Myriad’s commercials? Ellen T. Matloff, director of cancer genetic counseling at the Yale Cancer Center, summed it up neatly for the New York Times piece:
“It really preys on the fears of our society, and one of those fears is getting breast cancer.”
Essentially, Myriad is attempting to convince women to be afraid of what lurks in their genes (understanding that many women are not knowledgeable about this topic), and to convince them to seek this expensive testing, ultimately benefiting Myriad’s bottom line if not the women themselves.
Connecticut’s Attorney General is sufficiently suspicious of this strategy as to have launched an inquiry, stating, “We’ve determined that there’s enough serious and significant doubt about the accuracy of some of their claims that we feel a strong need to investigate.”
For related information from Our Bodies, Ourselves, see “Genetic Testing and Inherited Risk,” “One Woman’s Story with BRCA1,” and this recent news item suggesting that breast cancer patients with and without the mutations have similar survival rates.