On its surface, the idea of at-home genetic testing seems hard to resist: You order the test, get a box shipped to your door and submit a saliva sample. Wait a few weeks and you get a report that forecasts your risk of disease based on your DNA.
All this sounds wonderful, but the medical community’s reaction to it has been mixed. As at-home genetic tests grow increasingly popular, here’s what you need to know to keep your employees’ health in good hands.
Benefits and Potential
If convenience and affordability are two of the reasons these tests appeal to consumers, another is that they scratch the itch of curiosity we have about ourselves. Depending on how reliable it is, the promise that at-home genetic tests can give us access to accurate information about our health means that there’s a chance they could be an important tool for ensuring your employees’ long-term health.
At the same time, the fact that so many people have shown interest in disease prevention means a great deal about the state of health care. With hope — and perhaps some help from you — your employees can translate that gusto into equal interest in other healthy lifestyle behaviors like better nutrition, exercise and mental health. If your employees are expressing interest in the tests, use the opportunity to discuss the full range of health and wellness benefits you provide.
Increased awareness about genetic screening makes everyone a better health care consumer. We should all be curious and ask questions about our family history, if possible, to consider risks before they become issues. But whether to engage that curiosity through the likes of an at-home test or with an experienced clinical team is up to your employees. Encourage them to consider both. If an at-home test is the first step that prompts an employee to start a new conversation with their doctor, then it’s a useful option to have available.
Questions and Concerns
All that said, these tests do seem to come with their share of potential limitations, catches and pitfalls. If your employees are hoping to glean some financial benefit from cheaper at-home genetic tests, for example, they should know that many of them aren’t covered by insurance. Among the biggest names in direct-to-consumer genetic testing, 23andMe explains on its site that it’s not covered because it’s “not a medical genetic test.” On the other hand, if patients visited a doctor’s office and showed a medical need for genetic testing — say, a family history of cancer — that testing would cost more but also be more likely to be covered by insurance, as Consumer Reports notes.
The recent deluge in direct-to-consumer genetic testing aggressively markets to patients without including a whole lot of health counseling, something many experts claim is an essential part of the genetic-testing process, according to NPR. For example, you might get a positive result on a genetic variance that raises your risk of breast cancer, but if you were to get that result in a doctor’s office, you’d get the benefit of talking about it with a genetic counselor trained in answering questions. Having your questions answered by a professional could be crucial to getting the help you need — or saving you loads of undue stress.
A final clinical issue that experts take with these tests is their uncertain accuracy. On the heels of a March 2018 Genetics in Medicine article that showed a 40 percent false-positive rate in direct-to-consumer genetic testing, media outlets like Huffington Post and The New York Times told tales of patients wronged by inaccurate results. Similarly, lack of comprehensiveness is a concern. Take, for instance, one test for certain DNA mutations, called BRCA genes, linked to breast cancer. While the test cleared Food and Drug Administration (FDA) approval in March 2018, the FDA noted that the “[t]est only reports 3 out of more than 1,000 known BRCA mutations and negative result doesn’t rule out increased cancer risk.” So you might not have those exact three mutations, but you could have any one of the others. One physician from the medical journal STAT pointed this out shortly following the test’s FDA approval, as did contributors from the American Cancer Society and the American Academy of Family Physicians.
So while at-home genetic testing does hold promise as a useful way to engage your employees’ interest in their own health and even precipitate important conversations with their doctors, the risk of false or insufficient information could be harmful. There’s no need to pan companies like 23andMe among your employees, but you should urge them to shop wisely, investigate the full picture and consider what other, more foolproof options they have for managing their health.
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