Insurers Urge Genetic Testing For High-Risk Women

Health care providers and insurers agree that it's in everyone's best interest to refer women for genetic testing if their family history of breast or ovarian cancer puts them at higher risk.

What they don't agree on is what should happen before testing, specifically whether women need to be advised by a certified genetic counselor or someone with similar training before the test is ordered.

On the one hand, obstetrician-gynecologists say that counseling patients about hereditary cancers of the breast, ovaries, uterus and other reproductive organs is part of their normal routine, as is counseling pregnant patients about prenatal genetic testing.

As licensed physicians, they are considered competent to provide this type of care.

"This is what we do," said Dr. Mark DeFrancesco, the immediate past president of the American Congress of Obstetricians and Gynecologists, noting that most physicians have been taking family histories since medical school.

"There are simple-to-understand criteria for who should be considered for genetic testing, and it usually has to do with whether you or someone in your family has had cancer."

DeFrancesco recalled a patient whose mother, grandmother and maternal aunt all had breast cancer, but the insurer required she see a genetic counselor before testing would be approved.

In such cases, "it will take a few extra weeks to get tested, and she might decide not to bother," he said.

DeFrancesco said genetic counselors have an important role to play after testing has been done to help patients who test positive for a genetic mutation understand the results.

In a statement released last December, the physicians group said it opposed such a restriction and warned that it limits patients' access to care.

Insurers sometimes take a different view, although their rules vary.

Two national insurers, UnitedHealthcare and Cigna, require women to receive counseling by a certified genetic counselor or other professional trained in cancer genetics before they will approve coverage for tests that look for mutations in two genes, BRCA1 and BRCA2, that increase the risk for breast, ovarian and other cancers.