The Daily Briefing's Dan Diamond spoke with Lindsay Conway, the Oncology Roundtable's practice manager, about the latest news on genetic testing.
Q: Monday’s Daily Briefing has a story on Cigna’s first-of-its-kind approach to require counseling before patients can get genetic testing. Before we talk about the specifics of Cigna’s new policy, can you explain what genetic testing entails?
Conway: The term “genetic testing” can be used to refer to two separate categories of tests in oncology: The first kind is testing for a person’s genetic predisposition for developing certain cancers, which is what Cigna’s new policy focuses on. That’s relevant both to patients who have not been diagnosed with cancer, but who have a family history of the disease, as well as to people who have been diagnosed with cancer and are making a decision about which type of treatment to pursue.
The second kind of genetic testing determines whether certain therapies will be effective to treat an individual’s specific cancer. That’s also known as molecular diagnostics.
Q: Cigna’s stated motivation is interesting—the insurer says it wants to avoid spending on unnecessary tests (which can be pricey), but also reduce the risk of unnecessarily alarming patients. Any quick reaction to this news?
Conway: It's a smart move on their part to reduce inappropriate testing.
As you said, genetic testing is very expensive. And most physicians don’t stay up-to-date on which genetics tests apply to which patients, let alone how to interpret the results. Moreover, not all patients are good candidate for genetic tests. It really only makes sense if you have a family history of the disease, or multiple risk factors.
Q: So that gets to a follow-up question: Who should undergo genetic testing?
Conway: The National Cancer Institute has a helpful article with some recommendations for who should get BRCA testing here–see under question 4. According to their analysis, only about 2% of women are good candidates for BRCA testing.
Q: In theory, requiring patients to get counseling before testing will winnow the potential pool of people being tested. Simply put, is this policy a positive or a barrier for patients?
Conway: Personally, I like the Cigna requirement as it basically ensures that a genetics counselor is getting involved and making a (probably more) informed decision about whether the patient is a good candidate and which tests are appropriate. Hopefully, it also makes it more likely that the genetics counselor is involved with interpreting the test results and counseling patients on how to act on them, which is another area where doctors tend to perform poorly.
Q: Does the Oncology Roundtable have any additional resources that can shed light here?
Conway: It sounds like Cigna’s partnering with Informed DNA to make this happen. We’ve written about Informed DNA on our blog–how to outsource genetic counseling to meet Commission on Cancer standards, and how to outsource genetic counseling from the provider perspective.
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