I’m planning to get back to my nature/nurture series sometime soon, with a post about genes and the environment, at which point I’ll also be writing about genes and cancer. But in the meantime, the BRCA genes and breast cancer are in the news, with Angelina Jolie’s decision to have her breasts removed, on learning that she carried a gene that gave her an 85% risk of getting breast cancer if she left them on. As it happens, I already know a bit about the company that offers this genetic testing (not the one I tested with, which is a less expensive consumer genomics company that tests only for a few of the BRCA variants, but one that offers more expensive medical tests), because I got genetic counseling, after I finished treatment for endometrial cancer, to see whether my family history indicated enough risk to refer me for further testing for something called Lynch Syndrome, that dramatically increases the risk of endometrial and colon cancer. The question came up, on the 23andme forums, why the Myriad test was so much more expensive than the 23andme one. I am reproducing, as a blog post, the answer I gave there:
23andme tests some BRCA1 and BRCA2 variants; Myriad tests, to the best of my knowledge, for all known BRCA1 and BRCA2 gene variants. There are two aspects to this. One is that it really is more expensive to test for all variants (whole genome sequencing costs way more than 23andme’s $99 test, and can’t currently be offered at 23andme’s price). The other is that Myriad owns patents on testing for certain important BRCA genes, and 23andme can’t legally do the same BRCA testing that Myriad does, at this time. (I’m not sure exactly how this works legally; will the ability to test for the genes go generic at some point in the future, the way pharmaceuticals do?) Myriad has a number of cancer specific tests, which test for the genes that increase risk most for a particular cancer. There is one for hereditary breast and ovarian cancer, one for hereditary colon and uterine cancer, one for hereditary colorectal polyps and cancer, one for hereditary melanoma, etc. If you have a likelihood of cancer in your family, you see a genetic counselor first, and then get referred for the Myriad test. If your family risk is high enough, and depending on your insurance company, the test may be covered by insurance. Likely, with Angelina Jolie’s family risk, her test was covered (but then, she has the money to pay thousands of dollars for the test anyway). All of the tests cost thousands of dollars.
I didn’t, in this answer, talk about how much of Myriad’s higher cost is due to actual increased cost in looking at all the gene variants for the cancer genes they cover, and how much is due to their being able to charge more because they have patents on certain tests and don’t have competition. The reason is that I don’t know the answer. (Note that the test that I would have gotten from Myriad if I had met Amsterdam criteria for Lynch syndrome also would have cost thousands of dollars, and I don’t know that Myriad has patents on those genes.) Blogs and articles have been debating the matter, though, in the wake of Angelina Jolie’s revelation, as a case regarding the limits of said patents makes its way to the Supreme Court (Association for Molecular Pathology v. Myriad Genetics), so here are a few links:
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Tags: Angelina Jolie, Association for Molecular Pathology, BRCA1, BRCA2, breast cancer, gene patents, genetic testing, Myriad Genetics