Right now, it would be possible for all women to be tested for the BRCA1 and BRCA2 genetic mutations. However, not everyone agrees that this potentially lifesaving genetic screening should be made available to every woman. Women should, at the very least, have this test made available to them by their health care providers, so that they can make their own choice about whether or not they want to have the test done.
Knowledge truly is power in the case of the BRCA1 and BRCA2 genes, because if a woman knows that she has the marker she and her doctor can be vigilant about frequent testing which would allow for early detection and treatment. Professor Mary-Claire King was instrumental in finding the first breast cancer gene, BRCA1, in 1990. Today, she says “to identify a woman as a carrier only after she develops cancer is a failure of cancer prevention.”
Last September, King, Professor Ephrat Levy-Lahad (one of the world’s foremost authorities on inherited breast cancer among Jewish women), and Professor Amnon Lahad (researcher at The Hebrew University of Jerusalem) used the Journal of the American Medical Association to argue that current practice isn’t good enough. “Based on our 20 years’ experience working with families with cancer-predisposing mutations in BRCA1 and BRCA2, it is time to offer genetic screening of these genes to every woman, at about age 30, in the course of routine medical care.”
Sadly, while the costs are still being investigated (test and counseling) versus savings (avoidance of cancer and cancer treatment) to deliver testing, woman are not being helped who could be helped.
It all seems to come down to money. Karuna Jaggar, executive director of Breast Cancer Action, says it will cost 50 billion to test all the women in the United States aged 30 or over. “I took a very conservative price of ,000 per commercial test. It’s easily more than that!” And Katherine Taylor, acting chief executive of Ovarian Cancer Action, is also worried about the financial cost of systematic screening. “It would ultimately be quite a burden on the health system to routinely screen everybody for BRCA.”
If a woman in the United States wanted to pay for testing herself via 23andMe she would be unable to receive results for the BRCA mutation because in the United States the Food and Drug Administration [FDA] has currently stopped the organization from issuing these results. In Europe, the results DO include the three most common BRCA mutations.
Judy Garber, Harvard Medical School professor and director of the Cancer Risk and Prevention Clinic in the Dana-Farber Cancer Institute, says that in time, “we should be able to do this for everyone, not just for their breast cancer genes but for all their genes with one test, but we’re just not quite there yet.”
This genetic screening should not only be available to the wealthy. Angelina Jolie, who has a BRCA1 mutation, was famously able to use her knowledge to opt to have a prophylactic double mastectomy. She also recently had her ovaries and fallopian tubes removed. Women who carry these faulty genes can take preventative measures—things like regular breast screening, risk-reducing surgery, and the use of cancer-preventing drugs.
It is mind-boggling that a test is for BRCA exists and not all women are being offered it.