Caution advised over benefits of £30 cancer risk test

Health experts warn that breakthrough test for prostate and breast cancer could cause unnecessary fear

Newspapers have been running stories recently about famous people such as Angelina Jolie undergoing major surgery, in her case a double mastectomy, to reduce the risk of developing cancer after being found to have a genetic deformity which makes the probability of the disease much higher.

The cost of tests to detect these deformities is still high, so there are still discussions taking place about how widely these should be made available.

But recently it was revealed that researchers are working on a solution that could be available within five years and would cost as little as £30 per patient.

This should be extremely positive for patients and for the healthcare system as those with a higher risk would be armed with knowledge that helps them to manage those risks by improving their lifestyle or seeking particular medical interventions. In contrast, low-risk patients could avoid unnecessary testing or treatment, saving the NHS enough money to more than cover the cost of testing.

But it won't be as simple as just taking a test. Patients will need to discuss the implications with their doctors both before and after testing to avoid them being overwhelmed by a bad result or made too blase by a positive one. There could also be knock-on effects, for example over whether high-risk patients can get life or medical insurance.

BBH this week spoke to Ana Nicholls, healthcare analyst at the Economist Intelligence Unit, about the pros and cons of such a breakthrough discovery.

She said: “The test being developed offers a cheap way to test people’s likelihood of developing two particular cancers, prostate and breast cancer. These have been chosen as research has found it is sufficiently easier and most effective to do these two tests. But in the future this could be extended to other cancers and other diseases.

“Genetic testing has been around for a while, but this tends to cost hundreds of pounds at the moment and it is a fairly unregulated industry. The question is about making such a test affordable enough to do it on large groups, and accurate enough that it is worth doing.”

In terms of the benefits, she added: “Obviously there are a lot of benefits in that it can help with a diagnosis when someone is showing symptoms, and in a preventative way as it can help determine who is at higher risk of getting these diseases. Once this is narrowed down it may be worth giving specialist drugs to lower risk the risk further, to advise on lifestyle changes, or to give treatment immediately.

“Currently it is not always very easy to identify cancers at an early stage which is the point at which we can kill them. This sort of test would be of great help in these cases.”

But there are also downsides to the testing. Nicholls explains: “In America there was a huge screening programme and they discovered there are problems with this. You do get mistakes where people are identified and they are not at risk, and others who are deemed not to be at high risk when they are. You may be worrying people who may not need to worry at all, or giving drugs that have side effects to people who would not necessarily need them.

“What if you are diagnosed as having a higher risk of developing cancer at a young age, but will not develop it until you are much older? People will be living their lives with the knowledge that they will die of cancer in the future. There are also implications if it is known that a child will develop cancer in terms of more abortions.

“There are insurance implications, too. Getting life insurance, for example, depends on the insurer knowing as much as you do about the risks. Insurers have so far agreed they will not ask about genetic tests apart from for Huntington’s Disease, but that might change as more and more people get the test done. At the moment it is only a voluntary decision on the part of insurers.

“While this is an exciting breakthrough and we are seeing much more of a shift towards personalised medicines in general, particularly those that look at prevention rather than cure, we do have to look at the ethics of such a discovery and ensure that it does not create a bigger problem and become a bigger strain on health services in the future.”

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