Universal Genetic Testing for Breast Cancer May Not be Good Policy
Although a broad BRCA-1/2 genetic testing program has been suggested for all US women, it is not recommended due to cost and lack of benefit.
It has been suggested that a broad genetic testing program for breast cancer be considered in the United States. However, a new analysis by California researchers has found that the costs may be entirely too high and there may be smarter ways of using a limited number of resources to prevent breast cancer.1
The analysis found that a very small percentage of women would benefit from universal BRCA testing. In addition, at a cost of up to $2,000 to $4,000 per test, this type of strategy appears to be an inefficient use of health care resources.
Researchers at the University of California, Los Angeles (UCLA) found that compared with universal screening, other diagnostic tools remain more efficient and might be more cost-effective. The current most widely used test is marketed by Myriad Genetics. According to the analysis, it sells for about $4,000, thus making it far too expensive to warrant universal screening.
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“I was surprised at how much the cost was for a life year saved with universal screening. I knew it would be expensive, but not over a million dollars,” said Patricia Ganz, MD, who is the director of the division of Cancer Prevention and Control Research at UCLA's Jonsson Comprehensive Cancer Center in Los Angeles, CA.
She said the cost of BRCA testing would need to drop by 90% for testing to be cost-effective for the whole population. Dr. Ganz and her colleague Elisa Long, also of UCLA, calculated that for every 10,000 women screened, BRCA screening could avert four cases of breast cancer and two cases of ovarian cancer more than family history-based testing.
However, the BRCA screening would only extend a woman's life by an average of two days. For 99.75% of women screened, a negative genetic test would offer no increase in life expectancy, nor would it eliminate the need for regular mammograms, according to Dr. Ganz.
She said of the 233,000 breast cancers diagnosed annually in the United States, only 5% to 10% are attributable to mutations in the BRCA genes.
Subsequently, Dr. Ganz said if only 1 in 400 women across the country have one or both of the BRCA-1 or BRCA-2 mutations, universal screening would cost $1 million to $2 million to detect a single BRCA mutation, or nearly $400 billion to screen all women in the United States.
Dr. Ganz contends that this money could be better spent on other diagnostic tools such as magnetic resonance imaging.