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New genetic test reveals prostate cancer risk

High Tech Crystal Ball

For a mere $350,000 you can purchase the full sequence of your genetic code.

That’s what Dan Stoicescu did last January. Dan made millions in biotechnology, so he can afford the fee. And as a scientist, he knows that the future of healthcare will rely on genetics as the ultimate tool in preventive medicine.

Dan recently told the New York Times that he plans to regularly check advances in genetic research to assess his health risks, “like a stock portfolio.”

For instance, Dan can now compare details from his genome blueprint to the results of a new genetic study that reveals prostate cancer risk.

If you’re an average guy who doesn’t happen to have a few hundred thousand to shell out for a full genetic sequence, you can still put this groundbreaking prostate cancer information to use with a genetic test that only costs $300 – still expensive, but with the money you save you can buy an airplane.

Unfortunately, this testing brings up a worrying question: Do you really want your insurance company to know your level of risk?

High five

I’m not going to attempt a detailed examination of this new genetic study. Frankly, it’s way over my head and possibly yours too, so we’ll keep it simple.

A team of researchers from Wake Forest University School of Medicine, Johns Hopkins, Harvard School of Public Health, and two prominent research universities in Sweden, investigated five genetic markers in more than 2,800 prostate cancer patients and nearly 1,800 healthy control subjects.

Each one of these five markers are only moderately linked to prostate cancer risk, but researchers wondered if all five combined might reveal a more comprehensive picture. And they were right. Men who had a family history of prostate cancer and whose genetic code contained all five markers were more than NINE TIMES more likely to develop the disease compared to men who had none of the five markers.

But there are a few caveats.

First: The combination of family history of prostate cancer and all five of the genetic factors accounted for 46 percent of the total cases of prostate cancer. In other words, the test results can’t predict exactly who will get prostate cancer, only the potential risk in certain individuals.

Second: Subjects in this study were all Swedish, but researchers note that the five genetic markers are also found in black men, who have a higher prostate cancer risk than the fair-skinned Swedes. Nevertheless, researchers admit that a similar study to validate the results for a representative U.S. population is needed.

Third: The test doesn’t predict whether or not an individual’s prostate cancer might be aggressive or non-aggressive.

So these five markers don’t reveal quite all, but any man with a strong family history of prostate cancer might find his personal tests for these markers revealing.

Fear of testing

Sosay you take the genetic test and find that you’re positive for all five risk factors. How do you suppose your health insurance company might react to that news? Or when you try to purchase life or health insurance, will you be rejected? Will your premiums be higher? Might a prospective employer be reluctant to hire you?

These questions were weighed in a recent New York Times article that featured cases in which people have shunned genetic tests or gone to special lengths to make sure the results are private – sometimes not even sharing results with their doctors.

We can take some small comfort in knowing that the Americans with Disabilities Act prohibits discrimination based on health concerns. And a bill currently making its way through congress would prohibit insurers from denying benefits based on genetic information. But the insurance lobby in D.C. is powerful and influential. So if this bill becomes a law, what do you suppose the chances are that it will genuinely hold insurance companies at bay and protect the average Joe?

The Times article offers this quote from a spokesperson for America’s Health Insurance Plans: “Our industry is not interested in any way, shape or form in discriminating based on a genetic marker.”

Right. And I hear that later tonight cows will be jumping over the moon.

The Times notes that when Georgetown University researchers asked insurance underwriters to assess hypothetical applicants, in certain cases underwriters said they would charge more for premiums and even deny coverage based on genetic test results.

Clearly, we’ve still got a long way to go in the genetic testing game.

Sources:
“Gene Map Becomes a Luxury Item” Amy Harmon, The New York Times, 3/4/08, nytimes.com
“Cumulative Association of Five Genetic Variants with Prostate Cancer” New England Journal of Medicine” Vol. 358, No. 9, 2/28/08, content.nejm.org
“Combo Test Identifies Prostate Cancer Risk” Richard Knox, All Things Considered, National Public Radio, 1/16/08, npr.org
“Fear of Insurance Trouble Leads Many to Shun or Hide DNA Tests” Amy Harmon, The New York Times, 2/24/08, nytimes.com

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