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At-Home DNA Tests Can Identify Health Risks, But There Are Pitfalls

Publication: Houston Chronicle 

All it takes is a little bit of spit to reveal health risks with at-home DNA tests, like 23andMe and Ancestry.

And that means genetic information is more available and affordable now than ever before, according to Dr. Dhatri Kodali, medical oncologist at Webster’s Texas Oncology–Deke Slayton Cancer Center.

“A decade ago, we didn’t have much access to genetics or genetics testing,” she said. “It was quite expensive and only available under a research umbrella.”

Now, individuals can easily prepare a sample at home and mail it off for results. But these at-home DNA tests can lead to more questions than answers, Kodali said — especially when it comes to cancer mutations.

Kodali believes at-home tests can be an important first step for patients who want to know their risk levels. But she also thinks that the tests can cause unnecessary anxiety and fear.

“What I see in my practice is patients who get their tests done and come in with the report asking, ‘What does this mean?’” she said.

She also has patients who find a lump during a mammogram or a mass during a self-exam, but, because of a genetic test not finding a gene mutation, feel that they are not at risk for developing cancer — even when they are.

“It can be good, or it can give us a false sense of security,” Kodali said. “A false positive is devastating. A false negative can give you a sense of security when that’s not the case. It’s best when you can talk to a health care provider.”

A professional can explain, for example, that inherited genetic mutations only play a major role in 5 to 10 percent of all cancers, Kodali said.

“Carrying a BRCA gene doesn’t mean you’re 100 percent at risk,” she said. “It just puts you at an increased risk”

At-home tests can cause individuals to worry more than they should, she explained. “Sometimes, a normally healthy human being will now have this feeling in the back of their minds, ‘Now I have cancer. I’m a ticking time bomb,’” she said.

That may not be the best approach for patients, Kodali added, especially for those with more anxiety, who could become too stressed out with no professional standing by to explain the results of a genetic test. They might benefit more instead from a genetic evaluation at a clinic like Texas Oncology. Kodali said the center can home in on specific genes and individual risks factors.

“When they come in to a clinic for a genetic test, we’re involved, we’re sitting with them,” she said.

Kate Principe, certified genetic counselor and coordinator of the Gulf Coast region at Texas Oncology, explained that health care professionals can also look at family history and other risk factors.

“Genetic testing is not fortune telling,” she said. “It simply tells us what your potential cancer risk might be.”

One of the first things Principe asks patients is why they wanted to try genetic testing in the first place. “Is there something in your family history that made you want this information?” she asks. “What was your motivation?” Then she can tailor testing specifically to the individual.

“If you’re having any family history that concerns you, I would encourage you to bring that up with a family physician,” Principe said. “It’s better to bring that up than to let it fester.”

For patients concerned about family history, talking to a doctor before an at-home test is best.

“Even when we find a genetic cause for something, it’s not an inevitability,” Principe said. “It’s a risk factor. With most of these genes, we have guidelines for the next best step.”

If a risk is identified at a medical clinic, Principe suggests developing a plan with professionals who can help. That way, if an increased risk does develop, there are already doctors and oncologists who know the case and are prepared. “They already know you and have your best interest at heart,” Principe said.

Principe thinks that at-home tests have the potential to get more families talking about their histories and risks.

“A lot of stigma around cancer in general has decreased in the last one or two decades,” she said.

“Those at-home tests do have the power to get families talking and get more individuals thinking about family history.” Those are important conversations.

“I encourage people to have an understanding of health in their families,” she said. When there is concern, she said a certified genetic counselor can help. “We can go through all the nitty gritty of what it all means, and what are the next steps,” she said.

At Kodali’s clinic, practitioners work with three generations of family members to create a better understanding of risk. Then, they are able to consider specific genes for each individual.

“Preparing a person up front for all the possibilities opens up their minds more,” Kodali said. “They are more prepared. They get a bigger picture.”

With genetic testing and knowledge of family history, she said, patients can be proactive. They can opt for more in-depth imagery or be more vigilant with tests.

“Knowledge is power,” Kodali said. “They can be informed and know to look for certain things.”

Kodali pointed to Angelina Jolie’s preventative mastectomy after finding a BRCA mutation. “For her, it was an appropriate option,” she said.

At the same time, the celebrity’s decision was followed by an increased number of women who opted for double mastectomies, even when it may not have been needed.

“You have to understand your risk,” Kodali said. “Everybody is different, and how they feel is different. We have to try to inform them and offer them all of our knowledge, as best as possible.”

Doctors and surgeons are still learning about cancer and the best possible treatments, including ways to prevent recurrence.

“If cancer wants to recur, it can anywhere in the body, not just breast tissues,” Kodali said. “Taking away an organ does not mean you’re immune from recurrence.”

Not all mutations have the same associated risk, she added.

With better genetic testing, in the right scenario, Kodali said patients can be more informed and preemptive with their health. She also believes family members can benefit from sharing information.

“There are definitely benefits for genetic counseling and testing,” she said. “There has to be more knowledge and awareness. Prevention is my motto. I see too many advance stage cancer patients. I hope, in the future, we can identify patients earlier — and find a cure.”

This story originally appeared in Houston Chronicle.

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