Critical Issues in Genetic Evaluation for Cancer Susceptibility

In September 2008, Myriad Genetics Inc. will be launching a direct-to-consumer marketing campaign in Texas for its BRCA1 and BRCA2 gene tests. Mutations in the BRCA1 and BRCA2 genes are linked to hereditary breast, ovarian, and other cancers.

We anticipate that you will experience a significant increase in inquiries for this testing among your patients following the marketing campaign. We are taking a number of steps to ensure that physicians have adequate resources and support so that patients are provided optimal care in being evaluated for hereditary cancer. We have enclosed a list of quick facts for physicians that provide general information about BRCA1 and BRCA2 testing, as well as contact information for genetic counselors and nurses who specialize in cancer genetics in your area.

Because hereditary breast cancer may be caused by mutations in any one of a number of genes including BRCA1 and BRCA2, the interpretation of some genetic tests is not straightforward, and genetic evaluation may be very complex. Pre- and post-test genetic counseling has been recommended by professional organizations (American Society of Clinical Oncology, Oncology Nursing Society, Society of Gynecologic Oncologists and National Society of Genetic Counselors), and is integral to enabling a patient to understand the benefits, limitations, and cancer risk reduction options associated with hereditary cancer and genetic testing. Genetic counselors and other trained health care providers are available throughout Texas to conduct hereditary risk assessment and educate patients on the benefits and limitations of genetic testing. 

Similar direct-to-consumer marketing campaigns in other areas of the country have increased patient demand for cancer genetic services. However, it has been shown to increase demand for genetic testing among low-risk individuals, many of whom are not appropriate candidates for testing (Myers 2006, Williams-Jones 2006, Mouchawar 2005). Federal oversight of genetic tests and advertisements for genetic tests is limited. As a result, direct-to-consumer advertisements for genetic tests could overstate the benefits and utility of genetic testing (particularly for the general population) while failing to adequately address the risks, limitations, and uncertainties inherent in genetic testing. 

The Myriad Genetics direct-to-consumer campaign presents both an opportunity and a challenge. It will greatly increase awareness concerning genetic testing for hereditary cancer. No doubt, it will also generate some confusion about cancer risk and who is an appropriate candidate for genetic testing. We hope that this letter will provide the necessary resources to help you respond to questions from your patients that this campaign may generate. 

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Compiled by Sharon Plon, MD, PhD, Lois Friedman, PhD, Armin Weinberg, PhD, Lawrence Frankel, MD, and POEP staff. The POEP appreciates the efforts of all those involved.

For more information:
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