SAN DIEGO, CA – October 2. 2014 – Genetic testing provides the opportunity to gain all sorts of insight–from the potential to diagnose rare diseases, to providing targeted therapies, to prevention. Although we have historically focused on the use of genetic testing for diagnosis, less attention has been given to genetic testing’s clinical use in preventing disease and managing health.
In the US, only 2% of the population has ever undergone genetic testing. However many studies show that the majority of patients and physicians believe that genetic testing is on the rise and that a significantly higher portion of the population could benefit from genetic testing to help identify risk for and even diagnose preventable conditions.
We have taken this approach at the Medcan Clinic, a preventative clinic based in Toronto, Canada, where a team of genetic counselors work alongside physicians, specialists and other healthcare providers to offer services in the area of preventive health and wellness. In this setting, I have seen first-hand the impact that genetics and genomics knowledge can have on healthcare, not only related to treatment and diagnosis, but also to health behavior.
The preventative healthcare market is growing vastly and focuses on detecting disease early, when there is opportunity for treatment and improved outcomes. A large part of this concept is health education, of which genetics education–understanding how genetic factors play a role in overall risk for disease is often overlooked. We have taken the approach at Medcan to offer the option of genetic testing/screening, as part of our overall comprehensive health strategy to anyone who has concerns, or just wants to be as proactive as possible at managing their health. The process begins with an in-person consultation with a genetic counselor where we review family history, provide education, and assess the appropriateness of genetic testing in each particular situation. Most people opt for a test panel where genetic susceptibility is reported for a number of common diseases, allowing individuals the chance to gain insight into their genetic risks, and then use that information to improve health outcomes through prevention strategies and early detection.
Much debate has arisen in the medical community regarding both clinical and personal utility of genomic tests. More than 4000 clients have completed Medcan’s Personal Genome Testing and a subset of these clients have been surveyed to assess their satisfaction with the test and whether they report changes in their health care or behaviour. These surveys reveal that clients undergoing testing have a high degree of satisfaction and are likely to make changes to their lifestyle, including dietary changes, changes in physical activity and increased screening or surveillance.
Our model is unique, in that we have an educated, health-seeking, proactive population. However as awareness continues to grow around genetics through media and other channels and as DNA sequencing costs plummet and access to services improves through video-based technologies, we are likely to see an increase in requests for genetic testing. We saw this effect when the number of individuals seeking breast cancer genetic testing more than doubled after Angelina Jolie revealed that she had genetic testing for the BRCA1&2 genes. On the heels of this, Mary-Claire King, the award-winning scientist credited with discovering the BRCA1 gene stated publicly that “it is time to start offering this testing to every woman, at about age 30, in the course of routine medical care” regardless of family history–and that failure to do so should be considered a failure of cancer prevention.
At Medcan, we take the approach that if an individual has the opportunity to learn about a test in advance, is fully counseled on the risks, benefits and limitations and has a qualified professional interpret the test results, there should be few limitations on the amount of genetic information they can access. Of course, this statement is coming from an individual who has had her whole genome sequenced and who chose to make that information available online for researchers (and the public should they wish) to access. Not everyone who has the means and accessibility to genetic testing would choose to go the route of full open access, for a variety of reasons, however with the opportunity to improve health outcomes looking more promising; I expect we will continue to see a significant increase in demand for genetic tests in the years to come.
Jill Davies, M.S., CCGC, is the Genetics Program Director, Medcan Clinic, a preventative clinic based in Toronto, Canada, and a member of the Pathway Genomics Advisory Board.