Insurers and health care providers admitted that if women with family history of ovarian or breast cancer are put at a greater risk, they should be included in a genetic cancer tests program. However, they did not agree on what must women do before testing. They are now discussing whether they need guidance from a certified counselor or someone with a similar specialization before the tests.
Obstetrician-gynecologists mentioned that they are already counseling their patients about hereditary cancers of the reproductive organs, breast, uterus, and ovaries related to how they are counseling pregnant women about the prenatal genetic examination. Because they are licensed physicians, they could safely provide such type of care.
The past chairman of the American Congress of Gynecologists and Obstetricians, Dr. Mark DeFrancesco, said that the criteria for who should be rated for genetic cancer tests are simple-to-understand, and it usually analyzes if a family member has had cancer.
DeFrancesco recalled a patient whose mother, maternal aunt, and grandmother, all had breast cancer, but the insurer decided that she should first visit a genetic counselor before approving the testing. Because the process could be delayed by a few weeks, patients could decide that they do not want to get tested.
However, DeFrancesco believes that the genetic counselor would be more needed after the testing for patients who are positive for genetic mutations and need to understand the results.
Last December, physicians’ statement opposed the counseling before testing saying that it limits the patient’s access to care.
Insurers believe that before being tested for the mutations in two genes, BRCA1 and BRCA2, that raise the chance of ovarian, breast, and other cancers, women must be advised by a certified genetic counselor. UnitedHealthcare started asking for genetic counseling for BRCA tests in January.
Nevertheless, the U.S. Preventive Services Task Force advises that women with a family history of ovarian, breast, or peritoneal cancer should follow the genetic cancer tests first to discover if they are at increased risk for BRCA mutations, and if proved positive, referred for genetic testing and counseling.
Under the health law, if in-network providers offer the testing and counseling, women must not pay anything out of pocket.
Cigna’s medical officer for quality and clinical performance, Dr. Jeffrey Hankoff, was concerned that people would start to have tests ordered that they did not understand or were not needed.
Image source: Flickr
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