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Women should be wary of genetic risk ads

Myriad Genetics, a biotechnology company, launched an unprecedented direct-to-consumer television advertising campaign aimed at women concerned about breast and ovarian cancer.  While Wall Street may be happy, the campaign is fear of cancer to sell its test.
Myriad has launched a public-awareness campaign, including a TV commercial, for its genetic testing service.
Myriad has launched a public-awareness campaign, including a TV commercial, for its genetic testing

Myriad Genetics, a Salt Lake City biotechnology company, has seen its stock price rise in the past few days. My hunch is investors are responding to the company’s unprecedented direct-to-consumer television advertising campaign aimed at women concerned about breast and ovarian cancer.

It would be fair to say that this encompasses just about every woman in the world old enough to have heard of breast cancer or ovarian cancer.

Those investing in Myriad stock know that is a pretty big market for a company offering a test that can detect genes which dispose women to getting these cancers. 

In fact, it's too big a market. Myriad is getting awfully close to overselling its testing technology in the guise of trying to educate women about breast cancer. While Wall Street may be happy, the Myriad campaign is exploiting fear of cancer to sell its test.

Myriad is running TV ads, along with some radio and magazine spots, with the slogan “Be ready against cancer” in Boston, Hartford, Providence, and New York City for the next six months. The ads urge women who have a family history of breast cancer to consider getting tested to see if they have a mutation that also puts them at risk. The testing can cost over $3,000.

The ads don’t make it very clear that Myriad makes the test.

More about business
Now, paying that much money might seem worthwhile since women who have the genetic mutation have a very high risk of developing breast cancer and a high risk of ovarian cancer — much higher than women who don’t.

Myriad says that the ads are intended to be “informative, factual, positive and empowering with the goal of encouraging women to think about their family history of breast and ovarian cancers.” Some physicians would applaud any ad campaign that gets women thinking about their family genetic risk factors for breast and ovarian cancer.

I think, however, that these ads make more business sense for Myriad than for public health or for educating women.

It is true that certain genes can put a woman at much higher risk of breast cancer. But the genes Myriad offers testing for are responsible for only about 10 percent of all breast cancer. Nor does having the gene mean you will get the disease at a young age.

If you have the genetic mutations, you are at much greater risk of getting breast cancer — but it may not strike until your 50s or 60s. That is a long time off for someone in their 20s to be worrying about getting a cancer that could well be cured in two or three decades.

Many experts on genetic testing recommend the Myriad genetic test only for women who have close genetic relatives who had breast cancer at a young age — 40 and younger. Perhaps 2 percent of American women meet that criterion.

Not only is there a grave risk that the test is being pitched to women who don’t need it, it is not clear what women are to do if they do have the genetic mutation. At one extreme, some doctors recommend complete removal of the breasts to prevent cancer. But even that drastic surgery is not 100 percent effective.

If you already know you have a family history of breast cancer, then you can get frequent breast exams without having your genes tested. That's all you will do anyway — even if you test positive.

Ticking time bomb
Ironically if you watch the ad and then get the test, you could well do yourself some harm.

Some life and health insurance companies will not be thrilled to find out that a woman thinks she is at risk of breast cancer or ovarian cancer. They might drop coverage as soon as a test is sought. Others will certainly want to know if a test result is positive. As a ‘pre-existing’ condition, that could spell trouble down the road in getting the costs of treatment for breast or ovarian cancer reimbursed. Or a health-benefits manager could decide that someone with a ticking time-bomb cancer gene is not the sort of person they need on the health plan. There is not much in the way of legislation that protects women against this sort of genetic discrimination.

There is no doubt that this ad barrage will be effective. Wall Street already knows that. 

Many women will want the test that Myriad is promoting even though they are not at any particular risk of having the relatively rare genetic mutation, a condition which accounts for a small proportion of all breast cancer. Myriad says it wants to do good by raising public awareness about hereditary breast cancer. Maybe. 

But the company’s claim would be a lot more convincing if they were not using a shotgun ad campaign likely to yield a lot more lucrative testing than a more targeted campaign which could really inform the 1 in 400 women who might truly benefit from knowing their risk.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.