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Ethical consideration about health risk communication and professional responsibility
Published in Ulrik Kihlbom, Mats G. Hansson, Silke Schicktanz, Ethical, Social and Psychological Impacts of Genomic Risk Communication, 2020
Our current knowledge about rare genetic variants that increase the risk for breast cancer such as BRCA 1 and 2 (two tumour suppressor genes) has added to the ethical challenges of adequate risk communication. According to the lay-relevant website of the US NIH, ‘12% of women in the general population will develop breast cancer sometime during their lives… By contrast, a recent large study estimated that about 72% of women who inherit a harmful BRCA1 mutation and about 69% of women who inherit a harmful BRCA2 mutation will develop breast cancer by the age of 80’.1 Risk-reduction for those who have inherited the respective BRCA 1 or 2 mutations, includes several options, such as regular screening, chemotherapy and ‘preventive’ mastectomy. NIH recommends that counselling and genetic testing should only be done in particular cases with family history because both mutations are rare (2–3 in 1000 women of the general population, and only 10–15 per cent of breast cancer are related to these BRCA mutations), and genetic testing should only be done after proper counselling and in case of particular family history (Nelson et al. 2013).
From the small screen to breast cancer screening: examining the effects of a television storyline on awareness of genetic risk factors
Published in Journal of Communication in Healthcare, 2018
Erica L. Rosenthal, Sandra de Castro Buffington, Galen Cole
This study illustrates some of the unique challenges facing EE approaches working in conjunction with the U.S. entertainment industry. Although many entertainment professionals welcome the idea of developing compelling storylines around a variety of health issues, it is important to remember that their goals may not be fully aligned with those of the public health community. This particularly storyline succeeds in conveying factual information about breast cancer risk, but falls somewhat short in presenting a nuanced perspective on BRCA gene testing and subsequent risk-management approaches. In episode 417, the doctor briefly mentions Silver's family history of breast cancer in the context of advising her to get tested for the BRCA gene, but a viewer might come away with the impression that all women should be tested. This message is not entirely consistent with current evidence-based practice, which recommends genetic testing only for those with a family history of breast or ovarian cancer [24]. Silver, like Angelina Jolie, has the luxury of being wealthy, but in the real world, the BRCA gene test (not to mention mastectomy and reconstructive surgery) may be cost-prohibitive. Testing can range from hundreds to thousands of dollars and may not be covered by health insurance [25]. Similarly, alternative risk-management approaches for those who test positive, such as enhanced screening and chemoprevention, are not discussed in the storyline; rather, preventive mastectomy is presented as though it were the only option.
Prophylactic mastectomy for BRCA mutation carriers after ovarian cancer treatment: is it beneficial?
Published in Expert Review of Anticancer Therapy, 2018
Joanne Kotsopoulos, Steven A. Narod
In conclusion, we recommend that preventive mastectomy be considered for ovarian cancer patients if they are diagnosed through preventive surgery or if they have stage I/II disease. For patients with stage III/IV disease, we recommend that preventive mastectomy be considered if they are 10 years from diagnosis, are age 55 or below, and if they have a serum CA125 level within normal limits.