12 September 2007
A US television advertisement for familial breast cancer testing has attracted criticism from oncologists and geneticists, who say that advertising a specialised genetic test to the general population could cause anxiety among women for whom the test is not actually appropriate. Director of cancer genetic counselling at the Yale Cancer Center Ellen T. Matloff said: “It really preys on the fears of our society, and one of those fears is getting breast cancer” (see New York Times article). Inherited mutations in the BRCA1 or BRCA2 genes can confer a lifetime breast cancer risk of up to 85%, and an ovarian cancer risk of up to around 40%; however, only a small proportion of breast cancer cases in a population arise in women with a BRCA mutation. Normally, only women considered to have an increased risk of carrying a mutation based on their family history (such as several affected relatives, and/or early onset cases in relatives) are referred for genetic counselling and the option of genetic testing.
The advertisement is sponsored by BRCA 1/2 mutation test provider Myriad Genetics, and urges women with relatives who have had breast cancer to consider testing (which costs in excess of $3000). The company has reportedly defended the promotional campaign, which carries the slogan “Be ready against cancer”, as necessary to boost public awareness of familial breast and ovarian cancer, and prompt women with possible concerns to discuss them with their health care provider. However, some fear it is the beginning of an era in which companies will aggressively market genetic tests to the public; already, private genetic testing services offered via the internet (some with highly questionable clinical utility) are on the increase. Others are concerned at the possible impact on primary care practitioners and genetics services if large numbers of women are prompted by the campaign to query their risk, and/or request genetic testing.
The attorney general of US state Connecticut has ordered an investigation of the claims made by Myriad in the advertisement. However, Myriad president Gregory Critchfield has said: “The purpose of the BRACAnalysis public awareness campaign is to save lives" by identifying BRCA mutation carriers (see press release). He added that: "We are committed to working with healthcare providers around the country to provide useful resources for them to offer hereditary risk assessment, counseling and genetic testing to their patients". However, the key issue is what proportion of the women prompted to ask about genetic testing will be at genuinely increased risk of having a mutation, and whether direct advertising of this genetic test is appropriate.