To test or not to test? That is the question.

When my friend Annie asked her doctor for birth control, he refused to prescribe it due to her family history of breast cancer.  The latest research attested that for women with a certain “breast cancer gene,” birth control could have grave consequences. He told her she could take a test to find out if she had the gene, and if she didn’t, she could could take the birth control. Annie opted not to take the test, settling for careful usage of condoms in return for a contented oblivion about her medical destiny. Section 14 of the Nova special, “Cracking the Code of Life” immediately reminded me of Annie’s situation. Apparently she’s not the only one faced with this difficult decision.

The notion that genetics may increase risk is by no means revolutionary. According to the  Women’s Cancer Information Center, the idea that family history can increase risk for breast cancer dates back to Ancient Rome. A genetic test doesn’t seem necessary to tell women they should seek out regular check ups and monitor for lumps.

So my biggest question is — What does the test tell you? The daughter in the episode decides she doesn’t want to take the test because her options will be to either remove her breasts and ovaries or just be monitored and wait. I did a little investigation about what exactly was gained from the test.

Women with the BRCA mutation have an 80% chance of the developing cancer by age 80.  If they don’t have the mutation, they still have the same risk as the general population for developing breast cancer.  So a positive test result informs you that you will most likely get breast cancer, and a negative test yields that just have the same risk as the average woman.  I find two major issues about these results very troubling.

First of all, the test is simply an estimation.  Nothing in science is certain — that’s the first major concept you learn in elementary school. Scientists are far from having a full understanding of the disease, and the latest information is always changing.  My friend Annie actually takes birth control now because new experiments negated the previous conclusions.  The ambiguity of the latest scientific technology makes me question whether such emotionally charged and life-altering information should be released.

Secondly, there doesn’t seem to be concrete breast cancer prevention. Drugs and other more extreme surgeries are possibilities, yet they are expensive and still uncertain. Risk prevention measures after receiving positive test results seem virtually the same as those for the general public.  The lack of an absolute prevention path seriously detracts from the value of the test in my opinion.

Yet the complex decision is a personal one that varies for each individual. When it all comes down to it, nobody can know for sure what the future will bring.  To me, the magical anxiety about the mystery of the future is part of what makes life worth living.

-Laura D.

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~ by lauradolbow on January 31, 2010.

One Response to “To test or not to test? That is the question.”

  1. Yes, genetic testing is an estimation. It gives you the odds of you getting a disease. So if you have a family history of breast cancer, you go and get tested for the BRCA genes. You don’t have the variants. Are you going to stop getting yourself screened? I certainly hope not. On the other hand, if you do have the gene, that does not necessarily mean that you will ever develop breast cancer. But as you mention, each person has the right to choose for oneself. But I would rather not know and get the routine screenings like everyone else.

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