the New York Times article. Yet, Professor Lindeman urges caution, and advises against routine genetic testing.“ Testing is offered to people who have developed breast or ovarian cancer where there are features that might suggest a mutation is present,” he says.
The test is also extremely expensive as Myriad Genetics, a Utah-based company, patented the test and is currently the sole producer of it. In fact Myriad claims to own the rights to any test associated with the BRCA1 and BRCA2 genes and it has ruthlessly enforced that right, even though their test is inferior to one that Yale University was willing to provide at a much lower cost. The US Supreme Court has recently begun deliberations on the latest of a series of legal challenges to the granting of the patent that has been going on for over three years.
Referring to the fact that her wealth meant she has choices that other women do not have, Angelina Jolie observed that,“ the cost of testing for BRCA1 and BRCA2, at more than $ 3,000 in the United States, remains an obstacle for many women.”
Overdiagnosis Angelina Jolie’ s situation also differs in other respects from those of the average woman. She is a woman at high risk compared to the vast majority of women who take part in breast screening programmes and after a biopsy receive a diagnosis of breast cancer. It is now known that about a quarter of cancers detected are so small or slow-growing that they will never metastasise or cause any health problems.
Other women are told they have ductal carcinoma in situ( DCIS), a kind of pre-cancer in which abnormal cells are found in the milk-producing ducts. Before screening programmes were introduced, DCIS was rare. Now they account for around 25 % of new breast-cancer cases, and preventative double mastectomies among women in this group have risen by 188 % since the late 1990s.( 3) This despite the fact that between 50 – 80 % of DCIS cases will not develop into invasive cancer. In the USA the impact of such diagnoses turns thousands of healthy women into“ cancer survivors” every year, and fuels the culture of fear, adding to women’ s already exaggerated sense of risk of getting breast cancer.( 4)
The results of a large study of breast cancer diagnoses over the past 30 years appeared in the New England Journal of Medicine at the end of 2012. It found that despite substantial increases in the number of cases of early-stage breast cancer detecting, screening mammography had only marginally reduced the rate at which women present with advanced cancer and that there is substantial overdiagnosis accounting for nearly a third of all newly diagnosed breast cancers. The study suggested that more than one million women may have been unnecessarily diagnosed and treated.( 5)
Preventative options Professor Lindeman suggested that there were a number of preventative options such as“ close monitoring which includes MRI scans and mammograms starting at a suitable age,” and breast cancer prevention drugs such as Tamoxifen. As for mastectomy followed by breast reconstruction, he estimated that on average about 20 % of women in Australia found to be carrying the BRCA1 and BRCA2 genes opt for this option.( 2)
Mastectomy As the breast cancer survivor quoted earlier put it,“ having a mastectomy … is a huge ordeal. And reconstruction, while it can look great, will never have sensation. Not ever
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