What is your initial reaction to this news story?
Think
back to the "In the Family' film and discuss how screening for breast
cancer risk at birth may have impacted the lives of those in the film.
If
a cost effective screening process was developed, do you think children
should be screened and all parents informed about their breast cancer
risk directly following birth? Why or why not? Do you think such
knowledge will have an impact on future health outcomes? What are the
future implications of this research?
The study done by Whittemore et al. can be found here:http://cebp.aacrjournals.
Screening for Breast Cancer risk makes women more informed and aware of their future options. If a women finds out she is at a high-risk for developing breast cancer, she can take the appropriate steps to try to avoid the disease, including lifestyle changes and potential surgical options. But, not everyone sees knowing their genetic makeup this way. Some people would rather not know, so that they can live their life normally. This is a concept that is hard for scientist and public health professionals to understand, but it is a view that some members of society hold. Because of this, I think everyone who decides to undergo screening should be making an informed, consensual decision to be screened for the genes. If someone is too young to consent, their parents or guardians should be able to consent for them.
ReplyDeleteWith this in mind, I do not agree with the idea of mandatory screenings for these genes at birth. Having these genes does not put an infant in immediate danger, the way other diseases that are screened for at birth do. Forcing someone to know their chances of developing an incurable disease is not fair. A patient or their guardians should be told the facts and given a choice. Hopefully, if there is a family history of cancer, the parents would prefer a screening at birth to be able to help their child make good decisions in the future. If the screening is not done at birth, the child can always have the test done at age 18 when they are an autonomous adult. The extra screenings and mammograms would never start before adulthood anyway, so knowing sooner does not really give an extra advantage, but has the potential to cause a lot more anxiety.
The movie we saw showed the effects these genetic tests can have on people, loved ones, and families. It is a very serious decision to make, and this burden does not have to be dealt with at birth, it can wait. Parents should be given the option, and the reasoning behind it explained, but still ultimately given a choice.
Alanna brings up a great point by highlighting the fact that scientists and public health officials often can't see past the benefits of a new screening or intervention tool to realize that some members of the general public may feel more comfortable leading their lives without that information. This may prevent those individuals from learning about a serious ailment until it has progressed to a later stage, however, it is important to take the rights and wishes of individuals into consideration. Electing not to screen for a disease like breast cancer has less serious social implications than choosing not to screen for something like HIV/AIDS that could be passed on to infect others if the affected individual is not aware of his or her disease status. Therefore, from a social and ethical standpoint, I agree with Alanna that it is unwise to mandate genetic screens for breast cancer for all newborn children.
DeleteMy initial reaction to this news story was a positive one - I was glad to hear that the researchers could provide a little more insight and optimism to genetic screening, an area that brings about questions, confusion, and controversy. I cannot imagine the anxiety and stress that people are put through when it comes to trying to figure out the course of their lives. How can one make a decision that determines the fate of their life? Their choices affect not only them, but their loved ones as well. There are so many “what ifs” surrounding genetic diseases such as breast cancer, and so being better informed and prepared is essential when it comes to dealing with them.
DeleteScreening for breast cancer risk at birth would have impacted the lives of those in the “In the Family” film. The case that stood out the most for me was that of Linda Pedraza. Knowing that cancer ran in the family, Linda just wanted to live life to the fullest. I understood her perspective that she wanted to continue being young and in love without losing her womanhood. However, she developed cancer and unfortunately passed away, leaving behind her husband and two children. If Linda had undergone screening much earlier and taken preventative measures, then perhaps she would have received life-saving treatment. I felt more sympathetic to her story because the movie also included a discussion concerning Nicole, her 16-year-old daughter, and her chances of having the same experience as her mother. I cannot imagine how it feels for a child having to deal with such a tragic loss in addition to thinking about their own life or death. However, Nicole seemed set on not wanting to know her fate.
If a cost effective screening process was developed, I do not think that screening at birth should be mandatory, but it should rather be an option. I do not think that children should grow up with a mentality that they might die. I agree with Alanna in the sense that a child can make their own informed decision regarding screening and/or treatment when they turn 18, as an autonomous adult. They are still young, which is good, since the risk of cancer increases with age. A person at 18 can decide to risk their life to defend their country. By that age, people are most likely mature enough to make certain choices. Knowledge on screening definitely will have an impact on future health outcomes - physically, mentally, and emotionally, for those who are directly affected and their loved ones. However, more knowledge is needed. There needs to be more research and confirmation of studies such as the one from Stanford. I think that my stance would then change if I was convinced by more scientific evidence. The future implications of this research could bring up ethical issues - we would have to expect people to screen at birth in order to follow these cases and better inform research. However, this would bring more assurance to patients, families, physicians, and genetic counselors when it comes to making life-changing decisions.
The issue is that if you screen at birth and find that you are positive for the mutation, then would you live life the way you would truly want to, with something like that always ingrained in your mind and body? Or would that give you more incentive to live life to the fullest? Should you put off screening and not worry? Either way, the stress and pressure evidently surrounds those who have to deal with such decisions.
If a cost effective screening process was developed, children should be screened and all parents informed about their breast cancer risk directly following birth. This will allow healthcare providers to effectively track high-risk patients and treat the cancer should it ever arise. The odds of successful cancer treatment are significantly better when the cancer is caught early. Being screened early in life can allow women to be tested for breast cancer periodically so they can catch it early. However, the genetic breast cancer screening can be conducted in the teenage years. If a cost effective screening process were developed and equally as effective a bit later in life, I would recommend that parents wait until their children are older. This is because children cannot be tested or develop breast cancer, so waiting until an age when they can would reduce anxiety. If parents recognize the screening as a precautionary measure rather than a death sentence, such a screening will be widely accepted. It is better to be safe than sorry.
ReplyDeleteAlthough I am an advocate for early screenings, not all parents are. Thus, such a screening should not be mandatory. It should be recommended for parents who would like to take an extra precaution, but it is not absolutely essential in fighting breast cancer. I am not sure that breast cancer screening after birth will help significantly decrease the death rate from breast cancer, but I would personally prefer having the screening to be safe. As we learning in our Epidemiology course, it is successful intervention that beats breast cancer, not only screening. Despite being outshined by aggressive intervention, screening can prevent the emotional turmoil and health detriments of putting one’s body through cancer and its treatment at all.
I think Filiz brings up a great point at the end of the blog post regarding the physical and mental effects that fighting cancer can have on the patient. Personally, I also do not believe that genetic screening for an increased likelihood of breast cancer should be mandatory at birth. I believe that parents should be informed of all of the benefits and risks and be allowed to make the decision on their own. My basis for this reasoning was mainly due to the emotional stress that can come along with knowing your child is at a high risk for a deadly disease later in life. However, Filiz brings up a good point that fighting cancer would put the patient and his or her loved ones through extreme physical and mental stress and detriments as well. Ultimately, this is another huge piece to take into account when deciding whether to go through with genetic testing or not. Although the knowledge may be painful, being diagnosed with breast cancer without warning and the ensuing battle would be extremely painful as well. I still do not believe that testing should be mandatory, but doctors should properly inform their patients of the possibly life-saving outcomes that could result from genetic screening.
DeleteAfter learning about this new, early genetic screen for breast cancer risk I had a positive reaction to the news. Anytime a new screening is developed for a disease that is difficult to predict or treat, it is a positive addition to our medical knowledge, because it provides us with another tool to stave off poor health and maintain our well-being. However, just because new technology is available and may eventually become highly cost-effective, I do not believe there is any need to use that screening technology on all children at the moment of their birth. A condition like breast cancer would not actually develop in that child for at least a couple of decades, so it raises serious ethical and moral concerns to place the burden of a positive or negative screen for breast cancer on the parents of a child who was born just days earlier. If the child was born into a family with consistent, multigenerational evidence of breast cancer—like the family of the narrator of “In the Family” –then when the child turned 18 or 20, she and her parents/guardians could discuss the possibility of getting genetically screened for breast cancer in order to make any necessary lifestyle changes that might help decrease her risk.
ReplyDeleteAs public health students and officials, even if a genetic screen is effective and inexpensive, it is our responsibility to determine if and when it is in the best interest of families to actually make use of the genetic screen. While it is true that early screening for genes that predict increased risk of breast cancer could guide lifestyle changes that help reduce an individual’s lifetime risk of actually developing breast cancer, I strongly believe that it would be unnecessarily burdensome to give parents that information immediately following the child’s birth. Furthermore, even if parents could opt in or out of the screen, it also seems unfair that an affected child of parents who opt into the program would have to grow up with the constant knowledge that she (or even he) is at a heightened risk for breast cancer. Since this research developed an innovative computer model to predict gene-based breast cancer risk, it paves the way for the development of similar genetic screens for other types of cancer or serious diseases. As these new genetic screens are developed more rapidly and become available for widespread use, we must always consider the Wilson and Jungner criteria before deciding at what age to recommend a screening test or whether to recommend it at all. One of the critical criteria in a screening test is that earlier intervention or treatment of the condition should be more effective than later stage interventions. While this statement does hold some truth for breast cancer, it is doubtful that interventions to reduce breast cancer risk at 2 days old will be significantly more effective than interventions that could be implemented at age 20. Thus, while the research surrounding this new breast cancer genetic screen bodes well for the development of future cost-effective genetic screens for other conditions, it is unnecessary to screen for breast cancer risk in newborns.
I agree completely with Anupriya. She made a great point when she mentioned "it is doubtful that interventions to reduce breast cancer risk at 2 days old will be significantly more effective than interventions that could be implemented at age 20."
DeleteNewborn screening for a disease that would not impact the child until decades later has a cascade of negative consequences. Offering screening at a later age when the child (now grownup) can make the decision and be emotionally ready for its implications would be best.
You raise some really great points, and I agree wholeheartedly. I think that we, as a society, become obsessed and enamored with any type of new technology, especially medical technology. We are so wrapped up in the newness, that a lot of people forget to think about how effective it is, or if it is morally right or wrong. As you said it doesn't fulfill some of the Wilson and Jungner screening criteria, and I agree it is not right to force a child to grow up with a dark cloud over their head.
DeleteI think that screening for breast cancer risk genes is a great tool to have and I think it would be of great benefit for the process to become more accessible, simpler, and more affordable. As we progress further in being able to provide the general public with this screening, many more people will be able to alter their lifestyle in beneficial ways and to be more diligent in getting checked regularly for any signs of cancer. From a general wellbeing perspective this can only be a positive thing. As we've learned in genomics, gene expression can be altered by behavioral changes so there is a potential to reduce breast cancer rates if the public does have access to a kind of heads up about their susceptibility to the disease.
ReplyDeleteHowever, I agree with Alanna and Anupriya in that an early mandatory screening would put an unnecessary burden over those who screened positive for their entire lives, even though they have many years before any worrying would really be warranted. Most newborn screenings in place now seem to be for disorders that affect the newborns beginning in early childhood or just consistently in their lives. Rarely is there a newborn screening test for a disease that almost certainly won't affect the person for 30 years or more. Let alone a screening test for an indicative gene that only alerts the family about the possibility of this very far off disease. When I try to imagine my own life with the knowledge of a possibility of future breast cancer looming over me, it seems unnecessarily stressful and quite scary.
I support advancing this screening tool to the full potential so that it can be accessible for women who want to use it. But I also believe that it should be a women's own choice to seek out the information once they are adults. It would be useful to have a standard protocol for women's PCPs to inform them about the screening at an appropriate age, just as girls are informed about the cervical cancer vaccine at an appropriate age. Doctors can share the information, explain the benefits, and recommend getting tested. Ultimately, I think it should be up to the individual whether they want to be tested. Hopefully in the future, the screening will be simple and inexpensive and most women will choose to get tested.
I feel that screening for breast cancer at birth is a good way to potentially reduce the future risk of breast cancer in baby girls. I think that knowing whether or not your child has a risk of breast cancer when they grow older can be nerve racking but worthwhile because personally I would rather know about a possible risk and have my child not develop the disease then not knowing and them having the disease in the future. Not only that but I think it is unethical to keep medical information from parents as if it were a secret; however if the parents choose to not know that is a different story. Knowing the potential risks is always a good thing because as hard as it might be to accept the risks, the truth is very important to know. Future implications of this research will create a better image of which children could possibly get breast cancer. This will make the parents more aware of their children's health.
ReplyDeleteMy initial reaction to this study was excitement at the advancement with genetic screening. Whenever new discoveries are made, they increase the odds for better health for mankind, which is a wonderful thing. My next thought, however, was that this type of advancement has both positive and negative implications. Obviously, screening at birth will allow the family and their new child to be proactive in monitoring their child and adjusting lifestyle to try and catch any development of cancer very early. It also allows for consideration of more extreme preventative measures, such as a mastectomy.
ReplyDeleteWhile allowing for early notice of the potential for breast cancer may seem like a good thing, the person being delivered this health news may not feel that way. As our class saw in the film "In the Family", this type of early screening can cause a great amount of emotion for the entire family. It can put a lot of stress on the person with genetic markers, and their personal relationships. Additionally, while there is increased likelihood of developing breast cancer if you have certain genetic markers, there is also the small chance of not developing breast cancer. This news about genetic predisposition is very heavy to put on someone at a young age.
Considering both sides of the argument, I feel that screening at birth should be an available option, but not a requirement. No one should be forced to subject their child to genetic testing if they wish not to have it performed, or if they wish to wait and let the child decide when they are older. This type of news can be incredibly devastating if the child does have a genetic predisposition to develop breast cancer, and it would not be fair to force it on anyone. But it remains a great option for those that want it performed, especially if their family has a history of breast cancer.
The development of this research, and also the argument over whether testing should be done at birth, leads to a larger question. As we advance our understanding of the genome and become more effective at screening for different diseases, we may see ourselves entering a new age. The argument over mandating for screening for one disease may become expanded to more and more diseases. And if that occurs, we have no idea how that increased health information might impact patients, families, and even legislation surrounding genetic testing. Obviously all advancement is progress, but I think we must carefully consider the larger impact that progress can have.
Breast cancer creates a huge emotional and financial burden for women and their families across the globe. I believe that any efforts to reduce the morbidity and mortality of this disease (as with all cancers) should be considered. Cost-effective newborn screening would give families the knowledge necessary to protect their baby girls early on from lifestyle and environmental factors that increase the risk for breast-cancer in individuals with the genetic predisposition. They also would be able to make a plan early on with their physicians to conduct screening tests such as mammograms.
ReplyDeleteHowever, other factors are at play. A genetic predisposition for breast cancer is far from a diagnosis—families whose babies are screened would need to be educated about the nature of the test and what the potential prognosis is. Also, a positive screening test may create an unnecessary burden of worry for the child and her family, as we saw in “Family Ties.”
Because of the seriousness of breast cancer, I believe that this technology, if made cost effective, should be made available to all who want to utilize it. However, as cancer is not a communicable disease and the diagnosis of a predisposition carries a heavy burden, this screening test should not be mandatory. If families are educated about the nature of the test and the possible diagnosis, they can elect to have their child tested.
I have a different opinion and possible alternative to other views proposed here about mandatory breast cancer screening in infant girls. My solution to this problem is that testing is made mandatory but the results of this test are concealed from both the parents and the child until the child is eighteen. Under my proposed solution, the test results would be stored somewhere like they are with newborn blood samples.
ReplyDeleteThis is a complex issue even with my proposed solution because of how a parents beliefs are the primary predictor of what one's beliefs are going to be in life. It does become sort of a self-fulfilling prophecy for the children on whether they will be for or against knowing this knowledge just based on what view their parents hold.
Another complicating factor is that some people would also not be for giving the government this type of information and would use some type of slippery slope argument that this information could be used against you in a discriminatory manner.
I think this is the best solution though because this information will be readily accessible to individuals who truly do want to know their chances of developing a disease without having to go through genetic screening later. Also, if the individual does choose to access this information at eighteen then they will have plenty of time to make necessary lifestyle changes to limit their chances of getting breast cancer, develop a life plan that takes this risk into account, or even undergo a mastectomy.
Richard’s idea about concealing the results until the child is 18 is a great way to reconcile some of the ethical issues. It does raise the concern however, of having this secret information floating around the public health department for 18 years at a time. Another way to handle this might be implementing a mandatory screening test at 18 years old, although this would pose problems with decreased access to your target population.
DeleteWhile I feel that screening for breast cancer is important, I think that screening all female newborns at birth is far too early to perform the screening. In the "In the Family" documentary we watched in class, Joanna was devastated by the news that she tested positive for the BRCA mutation and extremely conflicted about whether or not to go through with the mastectomy procedure. If the decision process was that difficult for Joanna, who was in her early 30s (if I remember correctly), what are the emotional implications for girls finding out their risk at birth?
ReplyDeleteAs the article stated, there are certain lifestyle choices girls could make if they knew their risk of breast cancer from birth, such as getting regular mammograms, following a careful diet and adjusting their child bearing/breast feeding decisions based on their risk. However, aside from monitoring their diet, most of the things females can do to reduce their risk of breast cancer are not applicable until later in life. Thus, I feel that the genetic screening for breast cancer risk should be conducted sometime in the early teens, perhaps around the time of puberty, rather than at birth. There is no logic in burdening a young child or her parents with this information when there really isn't much that can be done to prevent the onset of the disease until years in the future.
As our genomic knowledge increases and screening becomes more accessible, it's important to remember that just because we can do something, does not mean we should. I believe newborn screening should only be used to identify diseases that have an early intervention in place or will begin to affect the child sometime during childhood. In this case, I see no benefit in identifying risk for breast cancer in newborns, and I think the screening should definitely not be conducted until later in the female's life.
I agree with Rachel but would actually even encourage testing to be delayed further, until women are at an age where they are prepared to make changes to support their own health decisions. If testing were to begin at puberty, I believe that it might even cause more panic and anxiety than if it were tested at birth. Most of the risk factors that can even be modified for children under the age of 18 are usually already( or should be!) kept at a baseline level of protection, such as a healthy weight and regular exercise.
DeleteAnother possible detrimental side effect of this early testing is that it could end up being wasteful. Why bother testing a female if there is no family history on either side that alludes to her being a BRCA carrier or mutated individual. While this testing can be life-saving, the gene is not found in a very large proportion of the population and it seems superfluous to screen all females.
Another issue this brings up is gender equality. Who would be funding all these tests? Are there any corresponding male tests of equal importance or need of funding?
While the idea behind screening an entire population has its heart in the right place, as Rachel describes, i believe it still needs some tweaking even if it were to be a possibility.
Although the potential to screen the entire female population at a reasonable cost may become a reality in the foreseeable future, I find this trend quite disturbing. After watching the film “In the family” and seeing how dramatically each individual, whether the woman with the mutation, a loved one or a medical professional was affected by knowing about their mutation, I feel like this would ultimately cause more harm than good.
ReplyDeleteFor instance, all the people in the film were at least eighteen and fully consenting adults before they were screened. If screening were to occur at birth, it takes away the aspect of consent. It also doesn’t seem necessary to put this pressure on the parent and subsequently the child since breast or ovarian cancer are unlikely to strike during adolescence. Also, the article speaks to modifying risk factors, however, there is little prevention that can be done at such a young age.
While I do support making screening more cost-efficient, I believe that a greater good will be served if the choice to screen is made available to every woman when they reach adulthood. Thus, the entire population could still be screened, but it would give the patients more control over the circumstances that they come to understand this knowledge. This genetic information can be critical, especially for women who are carriers. Knowing one’s genetic status would then allow the health care system to better allocate resources and time to patients who are more likely to be affected by the disease, which is life-saving AND more financially efficient.
After reading this article, my initial thought was that an early screening for breast cancer was a good idea. Having that information at such as early age, people can have more control of their lives and make conscious decisions to limit environmental factors to reduce developing breast cancer. And I still do think this type of screening is generally a good idea, but I think screening at a very young age has negative side effects, even if the screening process were to be cost effective.
ReplyDeleteI think if one were to screen at a young age, that person’s life becomes a number. The focus on that child’s life from birth will be trying to lower that risk percent down, and that the strongest identity of that child is the percent of getting breast cancer. Every decision made in the future will be based on that number, and I feel that the child will have fewer life experiences than a child who were to not get screened. One thought that I have is that the child would have to make the healthiest decisions to remove all possible environmental factors- but these decisions could lead to a “what could have been” mentality. For example, a child could not participate in a sport because medication and its side effects could interfere with the activity, or that a child may not have the opportunity to travel for fear of not being to access medical care. These examples are hypothetical and specific, but I am highlighting the possibility that being given a risk percent has the potential to deprive a child of experiences, especially if it’s a low risk that may never result in a cancer diagnosis.
I agree with most people who responded that having a screening this early could result in a lot of stress and emotional burden that may be unnecessary. I do believe that this type of knowledge will have an impact of health outcomes, but maybe not necessarily for the better. Having such information at an early stage can give parents many options, but also the stress of knowing the information can lead to negative health outcomes that may lower life expectancy. Because of this paradox, I think that screening should be done on a voluntary basis. I think that this screening, if it were to be mandated, should occur at later age, rather than at birth. If it happened at a later stage, the child will be more involved with her decisions as an informed patient and can better manage the stress that is involved with screening.
Initially I thought that this news story had a great message that should be addressed to the public- that genomic screening is useful and should be more prevalent in society today, especially for breast cancer. I think that the fact the genomic sequencing introduces a sense of optimism if very reassuring for many people with genetic-related diseases. I think that if a cost effective screening process was developed, that children should be screened and all parents should be informed about their breast cancer risk directly following birth. This is because breast cancer is the type of disease that is affected greatly by lifestyle factors and choices. Thus, if breast cancer is detected early, rather than being fearful of what future of the disease might bring, women will always have the cancer in the back of their minds and will alter their lifestyle factors- such as diet and exercise- in order to stay healthy. Women will also be more educated about their future childbearing abilities so that they can plan accordingly with their partners. I also think that the knowledge of breast cancer early on in life will have a large impact on future health outcomes. I think that it is important for doctor’s to be aware, if they are able to, of any potential disease their patients might have so that they are able to track any health-related irregularities. I also think that if more women have the knowledge about their breast cancer that more money and time will be devoted to breast cancer research and an eventual cure. However, future implications of this research might include people realizing some minor side effects that they have earlier in life due to the breast cancer. There also could be some harm to the research that may be associated with the patients- if say the patients are not satisfied with the immediate research that was found- or say if the research they find turns out that there are worse health implications that breast cancer poses that we don’t know about now. Overall, extensive research can introduce both good findings and some bad, so we should always keep in mind that there might be implications to projected research findings.
ReplyDeleteMy initial reaction to this news story was that whenever a medical test or procedure can lower the chances of getting a certain disease, it is always worth looking into. However, there are a lot of factors to consider regarding genetic testing. This study found that genomic screening for breast cancer is more effective than originally thought. This testing is not cost-effective at the current time, but if it were to become cost-effective in the future, it opens the door to the argument as to whether this screening is worthwhile.
ReplyDeleteAs with any debate, there are varying opinions when it comes to genetic testing. Some people want any test to be done if it even slightly decreases their chances of getting a disease or disorder. On the other hand, some think the mental effects the screening may have on the individual or his or her family may outweigh the possible positive effects of getting tested. For example, if someone screens positive for a gene that increases their risk of breast cancer in the future, this could encourage them to get the proper care necessary or to change certain aspects of their lifestyle to decrease the probability of breast cancer. Taking certain steps may likely be essential to preventing the disease. However, knowing that you are at a high risk for a potentially deadly disease can take a toll on you and your loved ones, especially if you know of this high risk from birth. The mental toll this can take can be extremely detrimental to the individual and his or her family, and the negative effects of this mental stress may, in some people’s opinions, outweigh the positive factors associated with the early genetic testing.
A similar debate came up in the “In the Family” film that we watched. In this case, looking at family history and having genetic testing done on the daughters helped to take the necessary steps to treat their disorders early and effectively. The treatment seemed successful, and the disorders seemed manageable, so I believe the family was happy that they had the screening done. Yet, this is not always the case.
Due to the varying viewpoints on genetic screening at birth, particularly for a disease as serious as breast cancer, I do not believe testing should be mandatory. I believe it should be up to the individual or the parents of the infant as to whether testing is to be done. In my opinion, it would be best if the healthcare provider provided the family with both the possible benefits and risks of the screening, both physical and mental, and then letting the parents, or the individual if she is of age, make the decision.
If it were to become cost effective, genetic screening for breast cancer may prove very useful in early intervention. Nevertheless, it should be left to the individual or legal guardian to make that decision, not the healthcare professional.
Initially, the inner science nerd in me found this news story to be very exciting and interesting. However, after watching “In the Family” I know how having knowledge of this risk can be very impactful on a person’s life. I don’t really know what the best option is because if we screen all newborns that takes away the right to choose whether or not a patient would like to have access to this information. We also know that just having the genetic markers doesn’t mean that the cancer will develop, but that the chance is much higher. Meaning, this is not a guarantee that breast cancer will/won’t develop and could cause a lot of unnecessary anxiety in the general population. On the other hand, if we did do the newborn screening, I believe that rates of breast cancer would go down because these families would be very proactive in lowering risk factors. Through proper education they may eat better, exercise more and not smoke. These good health habits would not only decrease breast cancer rates, but many other illnesses that are prevalent in our society which is definitely not a bad thing.
ReplyDeleteI agree with most other posts that the best option for this screening is to offer it to all young women when they are old enough to make their own choice. They should also be able to see a genetic counselor to deal with the many aspects of the results of the screening tests. These tests should not take away a patient’s power by being required but rather empower them by being another tool in preventing cancer.
The main purpose of screening for anything is to detect a disease early and to begin treatment as soon as possible. For the most part, screening is very effective and saves many people who would otherwise not know of their disease until it is too late. However, the benefits of screening must outweigh the risks. After watching In the Family, I've realized that the risks of screening are different for everyone - some more so than others. There are people who are so worried by the thought of developing cancer that they can't focus on their lives, and there are others who experience a sort of survivor's guilt after being screened and realizing that they don't have a mutated gene when their family members do. Whatever the reason, there are those who find that screening brings more anguish and anxiety than anything else. There comes a point when numbers and probability percentages become overwhelming and begin governing people's lives.
ReplyDeleteThat being said, the truth is that the World Health Organization lists breast cancer as "the leading cancer killer among women aged 20–59 years worldwide". Over the years, there has been a large increase in awareness for breast cancer, and I think that needs to continue. Although I do not think that screening for breast cancer at birth should be mandatory for everyone, I definitely think that parents should be made aware of the option and of the risks and benefits that it could have. Even though the results from the screening would obviously not be definitive and may not give much peace of mind, if people find that they have a higher predisposition for developing breast cancer, they will at least be aware and have control over some of the known risk factors, such as obesity, lack of physical exercise, and alcohol consumption.
If there is prevention and treatment available for a genetic disease why should we not be screening for it? Isn’t early intervention a main reason for success in many circumstances of disease. Breast cancer screening for all female girls may not be cost effective yet, but it will be and it will be worth it. Alice Wittmore and her team determined that the top 25% of gene combinations predicted s50% of all future breast cancers. Many women may not be aware of their increased risk, but if women were screened at birth early prevention can take place. Women can get regular mammograms, or other regular measures to monitor the absence or presence of cancer. If a girl knows from birth that they are at increased risk they can choose to change their life early on.
ReplyDeleteThinking back to the movie “In the Family,” if these women were screened at birth they would know they were at an increased risk from the time they were born. With this information they could make certain lifestyle changes to increase their chances of not getting breast cancer. For instance, the woman named Linda (I believe) died as a result of breast cancer. By the time she found a lump under her armpit she already had stage four cancer. If she was screened at birth she would have known she was at an increased risk for cancer and could get regular mammograms and consider getting a mastectomy and hysterectomy after she had her children.
I also think another thing to consider is that screening for breast cancer risk is not all that common and it’s a very emotional process. Perhaps if everyone is screened at birth it would make this a more regular process and a little less intimidating.
I strongly believe that if a cost effective process was developed children should be screened following birth and parents should be informed about their breast cancer risk. Although, there is not much to do with this information until a child gets older, they can make important lifestyle choices to decreases their risk, and the chances they go to the doctor more regularly will most likely increase. I think this information will affect health outcomes in a positive way.
However, there are positive and negative future implications of his information. Some people may take this information and make healthy lifestyle choices. Other people may take this information and feel it always glooming over their head, just waiting to get sick. I think if this screening is mandated at birth and people make healthy lifestyle choices and receive regular medical treatment it can be a really great thing.
At first glance, newborn screening for these variants sounds like such a good idea. Having the knowledge this early in life would allow the best possible shot at prevention. But it would be the only newborn screening test that is not immediately life threatening and the knowledge alone could impact healthy emotional development. This article only considers the medical factors, instead of a more patient-centered approach that considers the implications this knowledge could have on a child. It could be a heavy burden to carry your entire life. In “In the Family”, the test results were stressful and life-altering. One could argue that this was rightfully so, but the burden that was placed on the young woman who tested positive for the gene is not one that anyone would want to put on a person from birth. I would not impose a mandated screening test for this gene at birth. Some families might want the option, and if there was unlimited funding and access, the choice would have to lay with the family. I personally would not screen my newborn daughters for this gene because the implications aren’t immediately life threatening (unlike other diseases included in the newborn screen), and the burden of the knowledge is not something I think a child should have to grow up with. If it had the effect it had in the film on a thirty-year-old, I can’t even imagine the effect it would have on a teenager or young child. Some families might want the option, and that’s their choice, but it should not be mandated.
ReplyDeleteI agree with Emma that while this newborn screening could be useful, it should not be mandatory.
ReplyDeleteThe test predicts 50% of all future breast cancers - this is a good statistic, but it's not enough to make the screening mandatory regardless of how cost-effective it is. There are just far too many epigenetic factors involved with illnesses like breast cancer that the advice it would warrant is the same that is given without testing - live a healthy lifestyle and significantly decrease these odds. Choose not to, and that is a gamble with your health later on in life.
That being said, it is great knowledge that would significantly increase early detection rates among the high-risk population for breast cancer. Also, a woman who knows she's at a significantly higher risk for breast cancer will certainly care more about the health decisions she makes. It is a great option for those who want it.
If you force someone to take it who does not care about how they can change their lifestyle to reduce the risk of breast cancer, the odds of them actually changing their lifestyle is lower than if they chose to take the test because they cared.
Also, since this test detects the genetic combinations that predict only 50% of all breast cancers, there may be some people who walk away from this test with a false sense of security. They may believe that they can put whatever they wish into their body and they'll have no worries about developing breast cancer -- even though a possibility still remains.
Screenings may be a good public health measure, but a mandatory screening would not prove a significant benefit. It may be best to do these screenings only in families with a history of breast or ovarian cancer.
My first reaction to this new story was that we as a medical community should be working to make breast cancer screening cost effective. 1 in 8 women will be diagnosed with breast cancer and 5-10% of breast cancers can be linked to gene mutations. Therefore, the early we can detect the mutations in the genes that cause breast cancer (BRCA 1 and BRCA 2), the better the chance is that these women can change their diets and lifestyles, like we saw in the movie, "In The Family". Women would have a better chance of beating breast cancer and living a better life with it if they knew they were at a greater risk at birth than later in life. In the movie we were introduced to a woman who was diagnosed when her cancer was in a late stage and she may have been able to change her lifestyle and diet to beat the cancer if she was screened at birth.
ReplyDeleteIn terms of better health outcomes and future implications, this study is great jumpstart to screening more diseases. If more disease screenings can be cost effective then we can change the lives of patients for the better by implementing preventative measures earlier treatment regiments. With diseases like breast cancer with the majority of cases not being able to be detected by family history, screening for it would be extremely beneficial to women.
In my opinion, the problem here lies in whether it is ethical to put the burden of this information on the child. The child would get this screening when she unable to consent to the screening. It is possible that the child does want to know if she has breast cancer and maybe we should hold off the screening until she is 18 and can decide for herself. Although I would think there would be a minimal number of women who would think this way, it is something to consider. However, I also believe that this new study has made screening for breast cancer evidence based and therefore would be beneficial.
My initial reaction to this news story was that it is exciting that they have advanced in genetic screening for breast cancer. However, I am skeptical about having the screening occur at such a young age. I feel as if it is putting unnecessary stress and burden for a family to know if their child was screened positive for breast cancer. Yet, I do think that if a cost-effective screening process was developed, children should be screened and all parents informed about their breast cancer risk directly following birth but ONLY if the parent decides to have their child screened for breast cancer. I don’t believe that it should be something that needs to be mandatory right now. Breast cancer is a devastating disease that affects so many people’s lives. I personally know how much stress it can put on a family and so because of this I believe it should be decided by the family whether or not they should be screened.
ReplyDeleteI also like the idea proposed by Richard on how the results should be concealed from both the parents and child until the age of eighteen. The lifestyle choices that a girl will have to make if screened positive for the breast cancer gene is more applicable later in life. If a child is screened positive at such a young age there is not much a family can do but worry since most of the lifestyle changes are effective later in life.
I do think that such knowledge will have an impact on future health outcomes but I believe that this screening will be more beneficial if we there were early intervention programs for breast cancer. Newborn screening should only be mandatory if there are early intervention programs and the child is affected during childhood. I personally would not want to screen my daughter at such a young age because I would not be able to handle that information emotionally while I watch her grow up. In conclusion it is exciting that they have advanced in genetic screening for breast cancer however, I do not believe it should be mandatory right now to learn about breast cancer risk directly following birth.
As I was reading this article, I initially thought that screening newborns for breast cancer seemed a little counter-intuitive since the disease does not present itself, in most cases, until much later in life. However, I found myself starting to support the idea that if the a girl was equipped from birth with the knowledge of her breast cancer risk, then she would be better able to my adjustments earlier in life. This in turn could potentially mitigate, or at least lower, her risk. As I started to contemplate the implications that could arise from screening newborns for breast cancer, I began to change my view.
ReplyDeleteScreening for breast cancer risk at birth may have had a significant impact on some of the characters in the film, "In the Family". I think that if the main character had had access to this film, she still would have had a difficult time deciding on which preventive measure she would feel most comfortable with. I think the only difference is that she would have had more time to contemplate her options. Also the three sisters in the family from Washington state would have had piece of mind earlier in life, and would not have had to gone through so much emotional strain during the screening processed they underwent in their twenties.
I personally do not think that children should be screened and all parents informed about their breast cancer risk following birth even if a cost-effective screening process was developed. While there is a lot of good that could come from screen newborns for breast cancer, in my opinion, the risks do not outweigh the benefits. There are no prophylactic measures specifically tailored for newborns who test positive according to these screening tests, so how could it be justified that screening all newborns is the ideal option? The family of the newborn would have to struggle with this information as the baby grows up, and would constantly be worrying about what the next steps should be taken to lower breast cancer risk.
Having this kind of knowledge will undoubtedly have an impact on future health outcomes. It is entirely possible that preventive measures may be taken earlier in life, even in the event that the newborn who was screened actually would never develop the disease despite testing positive. It is not guaranteed that the newborn will definitely get breast cancer, even if they test positive for some type of genetic mutation. Aside from this implication, there is also the fact that this knowledge will cause much emotional distress on the newborn's family, which could induce other environmental problems. The baby may have to grow up in very stressed environment, which his/her family constantly worrying about the potential medical condition.
ReplyDeleteThe test predicts 50% of all future breast cancers - this is a good statistic, but in my opinion, it is not enough to make the screening mandatory regardless of how cost-effective it is. The knowledge of breast cancer risk would significantly increase early detection rates among the high-risk population for breast cancer.
A newborn screening test for breast cancer indicates a risk that is not an immediate danger. Not only should medical concerns be included in this discussion but healthy emotional development.
The implications this knowledge could have on a child are tremendous. It would be a heavy burden to carry your entire life. In “In the Family”, the test results were stressful and life altering for women in their twenties. The burden that was placed on the young woman who tested positive for the gene was one they consented for and it is not something that anyone would want to put on a person from birth. Joanna Rudnick experienced a crazy amount of pressure, guilt, and fear about the many decisions she had to make as a result of testing positive. How could a child be expected to grow up thinking about her future children and husband with the fear of cancer over their head?
On the other end of the spectrum, if a child tested negative for this, the family and child may have a false sense of security throughout their lifetime. Many epigenetic factors influence breast cancer incidence and families and people need to be educated about this.
Perhaps this test could be made available for women aged 25 and up. The decision would be optional and the knowledge of breast cancer risk would significantly increase early detection rates among the high-risk population for breast cancer. Also, if a woman knows she is at a significantly higher risk for breast cancer she will certainly care more about the health decisions she makes. It is a great option for those who want it. A delayed screening, until women are at an age where they are prepared to make changes to support their own health decisions would be most beneficial.
Screenings may be a good public health measure, but a mandatory screening at birth would not prove a substantial benefit, and may even cause more harm than good.
It's amazing that we are in a scientifically advanced era with breast cancer screening, starting at an extremely young age! The onset of breast cancer is usually after 30 years old. Having this screening technology permits a more cautious lifestyle if one has a higher risk due to hereditary conditions but also reduces the morbidity rate since they can catch the disease at its earliest stage, and even overall prevent it from happening if environmental factors are controlled. Thus, my initial reaction is excitement and curiosity to see how this would affect public health among women since it would hypothetically be cost-effective. However, after recalling the anxiety and extremely cautious lifestyle some individuals had gone through with early positive screening in the film, I could see how early breast cancer screening has its own set of ethical implications. I personally would feel burdened indulging in life with having the fear of inevitable disease development always in the back of my mind.
ReplyDeleteIf this screening does become cost-effective, I do believe it should be presented as an option to parents however not mandated. Once again, the onset of breast cancer is usually at a much older age and lifestyle changes would be around that time if a woman was to have the disease. I don't believe that newborn screening is a necessity. During the age of adolescence would be a more reasonable time to screen since having the information at an early age would be productive. There wouldn't be any treatment to ultimately prevent the disease until actually having it. Had there been a treatment, then I would definitely mandate the screening. I too find my colleague's idea of concealing the results of a screening and not disclosing it until the legal age of eighteen to be an effective and morally correct option.
If all newborns were screened, a prospective epidemiological study could be conducted to produce information for future studies/medical interventions and to see what exposures had affected the individuals who had the disease. This knowledge will definitely impact future health outcomes and benefit the general health of women. However, I think the results could also cause women to be more fearful of their lives knowing that certain exposures are correlated with breast cancer.
Regardless of what disease, genetic screening always goes both ways. Having the knowledge can either instill fear or push an individual to have an even more fulfilling lifestyle. It depends on how the person views a negative circumstance and how they react.
I am not sure how I feel about this news study. It is exciting and I think that it has potential benefits, and that is exciting. If this test can accurately predict the likelihood of a girl developing breast cancer when she is still an infant, which is a huge step forward. On the other hand, I do not know if I would want to know as a child that I have a higher risk of developing breast cancer, it would change the way that I lived my entire life. The girls in “In the Family” would most likely feel the same way, or at least the youngest sister in the family from Washington. They would have had no choice in the matter, they would be forced to know this information which could prove detrimental to how they view life and subsequently how they would live their lives.
ReplyDeleteIf the test was more cost effective I could see it being implemented in newborn screening, but I do not know if I agree with it. Breast cancer is terrible, but the number of girls who develop it as a young adolescent is very small. I think that if it becomes cost effective the family, along with the child should decide, given family history ect. It should ultimately be the girl’s decision as a young woman, because the preventative measures can still be taken, but it was her choice to take the test.
The future implications, as I stated above, is that this test may very well be incorporated in the Newborn Screening program, if it proves to be as accurate as is stated in the study. I do not know if the future health outcomes would change much though. Realistically, a lot of the avoidable risk factors are not avoided by everyone even if they try their hardest, but it will have to be tested with time to see for certain.
As many of the other responses, my initial reaction to this news story was that screening for breast cancer risk at birth could have potential benefits in the long run. The child’s parents would be able to influence the exposure of environmental risk factors, which would lower her risk, and the child growing up could then alter her lifestyle on her own. Besides thinking of screening by the individual, screening entire populations could most likely benefit in research and the development of treatments by determining other gene variants that increase the risk of breast cancer along with the 86 already revealed. However, I believe that with any screening, treatment, or research development, the potential risks also have to be examined before proceeding in its application to everyone. Screening for breast cancer at such an early age could cause an unnecessary, overwhelming amount of stress and pressure for parents to revolve around the knowledge that their child could develop cancer one day. This could possibly restrain the child from living a normal life compared to not having been screened at birth. Not only for the parents, but this could put a heavy weight on the child in having to worry about the gene and it’s possible mutation for the rest of their life until cancer takes its toll.
ReplyDeleteIn regards to “In the Family,” it would’ve been more beneficlal for the women who were already predisposed to breast cancer to be screened at birth. The very end of the article says, “We want to focus on those at the highest risk,” which to me makes most sense to me. The prevalence of breast cancer is about 126 of 100,000 per year and Caucasian women are at the highest risk of other ethnicities. I feel like this group of people should be more focused on in breast cancer screening in trying to lower their risks compared to those who are already have a minimal risk. On top of that, age plays an important role in the development of breast cancer, so it would be more appropriate to start lifestyle changes decades later in life compared to childhood and adolescence. Even if the test was cost effective, the potential benefits for the child would only be effective and more relevant later in their life while they would be facing immediate worry and stress too early in life. However I do believe that an increase in screening would definitely have benefits in future research and treatment innovations which will help humanity in general. Overall, I think that screening for breast cancer should not be mandatory and that parents should make an autonomous decision of whether they want to be informed if their child is at risk for breast cancer.
My initial reaction after reading this story I was excitement. I think that this information could be the first step of a major break though in breast cancer research, and maybe even treatment. The statistics given in the article I think are very promising and worth considering when discussing people’s susceptibility to developing breast cancer. As seen in the movie “In the family” knowing if you have the chance of developing cancer could be helpful while moving forward in your life. For example the mother of the little girl who has a family history of cancer was extremely relieved when she found out that her daughter did not have a chance of developing cancer. On the other hand, the family of the three sisters waited until most of the sisters were all grown up to see if they were at risk. The oldest sister was ready to make severe life changes and consider major surgeries if she was at risk in response to her results. She did not want to put her unborn children at risk. Once they found out their results, some of sisters were pretty concerned to what that meant for their future. If those women were screened at birth they would know whether they needed to ever think of these major decisions and if they did they would be able to make those changes early on and avoid a big dramatic moment of truth. By creating a cost effective screening at birth children could grow up living their lives in a healthy and low risk way if they do have the gene. I think that there is no trouble in knowing your likelihood of developing cancer. It gives people the ability to prepare if they need to and gives them a reassuring sense if not. Perhaps someone with risk of developing breast cancer would make an extra conscious to avoid things like smoking, drinking, and radiation. This would improve their health outcomes. And it is worth noting, a mutation wont 100% mean you are going to develop cancer and visa versa. But this is a good start to the research. This is a step forward in figuring out where cancer arises and who is at risk of getting it.
ReplyDeleteAs technological advances further enhance our understanding of the body and mind, we must be skeptical of chance. In other words, what’s the real price in trying to predict your future? There are two ideological concerns with this article: ethics and emotions. Ethically, by law, infants are considered incompetent and the decision-making ability is left to the responsibilities of the parents. However, when children grow older and upon the age of 18, the state re-assigns responsibilities back to the child. Though, this is mostly considered as a universal maxim (dependent on culture), most states follow the premise that an infant does not have the right to make his or her own decisions. Nevertheless, some courts do allow a well-informed child to make their own medical decisions. This most likely does not apply on the infant level. However, it is not fair to assume that all infants as they grow older, wish to know of their chances of developing a certain disease. Thus, at what point do we mandate screening for all children, even though some may not wish to know their fate, as they grow older. By issuing such actions, we are limiting a child’s right to experience a full life later on. For example, if a child is diagnosed with having a high probability of breast cancer at infancy, then they will make changes to their lifestyle to reduce the actual onset of disease. Thus, we have enabled them to reduce certain risk factors by making actual decisions surround their health. However, some may argue that we are saving life later on, yet there is no scientific backing that reducing some risks even with a high probability will actually prevent the disease. Thus, it is not fair to assume such notions. On the other hand, the notion of emotions, particularly fear. If a child is to be diagnosed with a high probability, they will forever live their lives in fear, not knowing if or when or how the disease will progress in their body.
ReplyDeleteTake for example, the ‘In the Family’ film, the lives documented were anxious from the moment they entertained the thought of being at a risk for developing breast cancer to the onset of the results and thereby after if positive for susceptibility. Thus, would knowing earlier really reduce that anxiety? It is true that there is a threshold for everything. So maybe knowing earlier that you are more susceptible will reduce your anxiety over time. It also may have reduced their risk by knowing earlier. However, at their age, they still have no onset of disease and will probably now begin to reduce risk factors. Thus, how much does screening at infancy benefit the patient? This is a question that needs to be answered before a statewide implementation of mandated screening efforts could be issued.
Directly screening infants for genetic diseases, such as breast cancer is still shrouded in mystery over future implications. We still need to research about using computational models to infer future data. Are these reliable? If so, by how much percent are they accurate? A lot of questions remain unanswered. Thus, I do not recommend children being screened for breast cancer risk. Future efforts to reduce the chance of breast cancer can be aimed towards increasing funding towards awareness campaigns and/or a vaccine that effectively eliminates the disease.
I believe that genetic testing for the breast cancer can and should be administered to newborns as long as the test is cost effective and benefits outweigh potential risks of the test. Similar to other newborn screening tests, such as for PKU, breast cancer newborn screening provides parents and healthcare providers with simple information about the risk factor for the disease. The test is most beneficial for newborn parents, who have the ability to develop and enforce healthy lifestyle patterns in their families. Although breast cancer does not develop in females until late 20s and onwards, creating positive behaviors and attitudes toward healthy dieting and exercising from a young age will likely stick with these children as they grow up and comprehend their risk factors. The already existing positive lifestyle has the potential to alter genes through environmental epigenetic factors.
ReplyDeletePositive newborn breast cancer screening tests, which indicate high risk, can provide motivation to parents to change their personal behaviors and attitudes toward healthy dieting and exercise, which in turn, will positively influence their children’s behaviors. On the other side, however, negative screening tests, or low risk results, may send a message to parents that they do not have to worry about developing better behaviors for themselves, and subsequently their children. This can be especially problematic for unhealthy parents who have a newborn with a low risk. They may not understand that, as with any person, their lifestyles and those of their child, can still influence the onset of cancers or other non-communicable diseases.
As seen in the film “In the Family,” understanding breast cancer risk from an earlier age allows more time to create new and healthier lifestyles choices. It can also alleviate incredible stress, such as in the case of the documentary’s director and protagonist Joanna Rudnick, who debated on whether to precede with surgical options to lower her breast and ovarian cancer risk or continue living without surgery. While her breast cancer risk was identified at a crucial stage in her life (as she entered her child-bearing years), learning of her risk factor from a younger age may have caused her to take action earlier. In conclusion, widespread newborn breast cancer screening tests can provide powerful information to families and at a time long before cancer development that crucial lifestyles changes can be created and sustained.
Positive newborn breast cancer screening tests, which indicate high risk, can provide motivation to parents to change their personal behaviors and attitudes toward healthy dieting and exercise, which in turn, will positively influence their children’s behaviors. On the other side, however, negative screening tests, or low risk results, may send a message to parents that they do not have to worry about developing better behaviors for themselves, and subsequently their children. This can be especially problematic for unhealthy parents who have a newborn with a low risk. They may not understand that, as with an other person, their lifestyles and those of their child, can still lead to cancers or other non-communicable diseases.
Sorry for the repeated second paragraph!
DeleteThis article raises a very interesting point of view and very exciting news! However, I remain skeptical of the external validity of these findings. As many of my classmates stated above, it is really fantastic if we can determine the genetic risk factors of various diseases. However, these tests predict 50% of cases that may develop into breast cancer in the future. This is an impressive statistic, but not enough. If a girl were to not be identified at birth it may have adverse effects on her lifestyle and create a false sense of security. She may become less likely to get mammograms in the future, and less likely to follow a healthy diet throughout her lifespan. The test automatically puts girls into one of two categories (affected and unaffected) however I do not believe that it is that simple.
ReplyDeleteMoreover, the test fails to account for the other 50% of future breast cancer cases who end up not benefiting from this early knowledge. I don't believe that it would be cost effective to administer this test at birth. However, I do believe that this test does provide a strong argument for genomic sequencing in showing the ability to predict future conditions. I think that before it is implemented on a wide-scale its predictive value needs to be increased to much greater than 50%.
Like most others, I first thought that screening for breast cancer immediately after birth was a good idea. The parents would know if their child was at risk for breast cancer while the child was young and the parents could modify their child’s life knowing that she is at risk for the disease. However, in the end, I do not think it is the best way to tackle the issue. If parents find out their daughter has an increased risk of breast cancer, they will most likely spend their lives worrying about their child. They will not even know if and when the time will come that their child shows any detection of breast cancer. I do not think this screening is very cost-effective. I would think that this screening test would have a high negative predictive value, which translates to among the population that screened negative for the test, a high number of the population does not have the disease. If a screening test has a high negative predictive value, it is not needed in the healthcare field. Public health officials do not need to be spending funds on a test that does not detect a high number of positives. Although knowing if a child has a risk for a disease, it might not be the best screening test to implement. It is a difficult situation because I think that any individual battling breast cancer right now might say that she wished she had known she was at risk at such a young age. I can understand that those battling the cancer would have wanted to know. We must compare the cost-effectiveness of both views. If the screening test were administered to every newborn and only a small number tested positive for risk of breast cancer, the screening would not be cost-effective. To compromise, it might be beneficial to screen for breast cancer at a younger age, especially if it runs in the family history. Or maybe it is possible to have the newborn screening for breast cancer available to parents if they wish to have their child tested. Then, it is not necessarily mandatory or a concern for funding. If parents are informed of any breast cancer in the family, they may opt for their newborn to be screened. If the screening is available to the parents of the child, they can choose whether or not they wish to find out if their child is at high risk for breast cancer.
ReplyDeleteMy initial reaction to the study was that given that there is still much more research to be done about breast cancer prevention, I do not think it is necessary that all newborns undergo breast cancer screening directly after birth. At this point, the benefits of newborn breast cancer risk screening do not drastically outweigh the cons. This newborn screening as of now if still expensive, but even if it were to become more cost effective I would stand by my position. It is great that so much research has gone into the genetic risk factors of developing breast cancer, but I think funding would be better spent towards developing more accurate screening tests or treatment plans for older women, who are at a much higher risk solely because of their age. We have learned that, on average, breast cancer develops later in adulthood. Knowing from day 1 (literally) if your child is at risk for breast cancer would just create a lot of unnecessary anxiety and suffering for both the parents and eventually the child. The study claims the screening could potentially detect 50% of future breast cancer cases, but when 80% of cases develop after the age of 50 anyway it doesn’t make a lot of sense to screen at such a young age. This is the reason yearly mammograms are not required until the age of 40. If the screening were to become extremely cost effective, I do not see the harm in offering to parents who are interested, but I don’t think newborn breast cancer screening should be mandatory given the nature of the disease.
ReplyDeleteScreening at birth for breast cancer is a great way to not only improve the quality of life for many women but to possibly even prevent the onset of the cancer. As we have learned in class, there are many factors that can affect the onset of disease other than ones genes. These can include environmental influences, diet, stress levels, and more. So these women are given the opportunity to know about their chances, rise up to the challenge, and lead healthy lives that don’t result in breast cancer. And as we saw in the film, the people who did not grow up with the knowledge if they had the gene or not, were put under a great deal of stress when they found out. It was a sudden, huge burden that was placed on their lives with little to no prior exposure. But if they had been given the information as a child, they could grow up being able to digest the information and probably with a lot less stress in their life. So overall I think that screening at birth can not only have a positive affect on the physical status of these women, but can have a positive psychological one as well.
ReplyDeleteI agree with Daniel that being screened can empower women to take charge of their situation, however, telling a young child (younger than middle school age) that they are at risk for cancer can really scare or even confuse them, and they would not really know what to do. Instead I feel like if screening is done at such a young age most of the precautionary steps would be taken and implemented by the parents, not the girl who was actually screened. However, if screening were held off till a later age like middle school age, the child would be better informed and understanding of the situation to take charge herself.
DeleteMy initial reaction was that it is great that there are more breakthroughs in genomic sequencing and I was amazed at the value such sequencing could have. In regards to the film, such sequencing generally had negative affects or resulted in a lot of tension or stress, but did have some positive outcomes. Joanna faced difficulties in her relationship with her boyfriend knowing she was at risk for cancer. The oldest daughter in the family of sisters, who was most prepared for the bad news, wanted to get tested and almost forced her siblings to do it to, only to find she was the only non-carrier. This resulted in her guilt and her younger sisters' stress and confusion. Olga was in a constant state of worry for the future of her daughter knowing she was at risk for cancer, until she was screened and found she was not a carrier and was immensely relieved.
ReplyDeleteI believe that if a cost effective screening was developed I do not think all babies should be screened. At such a young age children would not be able to understand or handle such news, and many parents who know their child is screened positive would have to keep this big secret till the child is old enough to know, and this could be very stressful. Instead, I believe children should be screened at an appropriate, but still young age such as 13, when they can better understand and cope with what is going on and could voice their opinions on the issue before getting screened.
I believe it does impact future health outcomes which is why I think children should get screened at a young age so they have enough time to alter their lifestyle to fit the screening result. Unlike other diseases tested during neonatal screening, cancer does not usually manifest until later in life, meaning screening can wait till an appropriate age. Many of the women in the film endured stress and strain knowing they were screened positive, especially those who were screened against their will, which is why it is important that screening should be held off till the child is old enough to understand the process, but still young enough where they can do something about it.
Screening processes like this one will influence more research into other genomic screening tests in the future.
At first, I had an overall positive reaction to this article. With earlier knowledge comes reduced risk, so I thought why not screen as early as possible? However, after thinking about the fact that breast cancer does not develop in most females until late adolescence, I realized that genetic testing for breast cancer at birth would not be that beneficial. Not only does this bring up the issue of consent, but it also deals with a range of emotions, mainly anxiety and fear. Infants do not have the capability of making informed decisions, and we cannot assume that they would want to know about their probability of breast cancer at such an early age. This testing benefits the parents by allowing them to enforce a healthier lifestyle for their child starting early, however this can also induce fear and stress to all parties. If a child is diagnosed with a high probability, they will constantly be living in uncertainty, not knowing if or when the disease will progress. Ultimately, this screening puts a lot of pressure on the family because there is little prevention that can be done at such a young age. Therefore, I think that the most sensible time to screen for breast cancer is during adolescence when there is a better understanding of the disease and a time when more precautionary measures can be taken.
ReplyDelete
ReplyDeleteAs a student of public health, I think prevention is important with respect to any disease. If preventive measures are known, then they should certainly be taken. Often times, even you know you will eventually develop a disease, preventive measures can help delay the onest of the symptoms of the disease. Additionally, most preventive measures are just components of a healthy lifestyle. Therefore, preventive measures such as exercising regularly and eating a healthy diet would be beneficial to anyone, regardless of whether or not they are at risk for the disease being tested.
However, I don’t know that making certain genetic tests mandatory is the most effective way to deal with the risk of developing a certain disease. My skepticism arises from the emotional effects on the three sisters featured in the video. Though the eldest sister was the most prepared for any bad news to come, she was also the one who ended up screening negative for the BRCA-1 gene. Her two younger sisters, aged 23 and 25, screened positive. The youngest girl mentioned at a point in the video that she slightly felt pressured into getting tested because her sisters were, and even if she didn’t get tested she would almost feel obligated to do so anyway because the results of one of her sister’s test would make her curious about her own. In a sense, she was obligated to get tested if any of her sisters wanted to get tested, which was exactly the case.
In a public health context, it is important to determine whether the test is worth administering irrespective of accuracy and cost-effectiveness. Even if a test is cost-effective and accurate, there are other factors such as emotional responses that need to be considered. Often time, predicting the responses of people who are receiving the information delivered by genetic tests can determine these decision of whether or not these tests should be mandatory. However, as the determination of disease state is largely a personal decision, depending on a variety of factors, making the screening of diseases mandatory when a child is very young with essentially no autonomy seems very unethical.
Technology proves at a rapid pace, and some wonder if we should use technology that we have (and are developing) to screen newborns for the risks of breast cancer- screens that we currently do on adult women. I am skeptical when reading this article if it will truly benefit girls and women. Yes, I understand that knowing the risk their entire life might shape the decisions they make for the better. However, I find there are a few loose ends that need to be addressed.
ReplyDeleteFirst, I worry about the mental health of girls who are screened and test positive for these genes. As we saw in the in-class movie, many women had severe emotional reactions to finding out they were positive- and they were grown women. Growing up knowing you are at risk may instill a fear, anxiety and worry in girls that is premature, before they are old enough and mature enough to make decisions about what they want to do.
Second, it worries me that young girls will grow up with certain discrimination if known that they have this gene. The fact that it is only being tested on girls already sets up some discrimination, and having that screening done before you are autonomous and are able to make the decision to get screened (privately or openly) seems invasive and opens up opportunities for discrimination on top of the already existing emotional burden.
Although I see the benefits of this genetic testing and see that it has potential to empower women to make good choices from an earlier age, I'm not convinced that girls at a young age are ready for the emotional burden that it may lead to, as well as the mature decisions that need to be made, or the discrimination that may follow. I think that this genetic testing should remain available for women 18 years of age or older.
I think even if a cost effective screening process was developed, I do not think children should be screened and all parents should not be informed of their child's risk of breast cancer directly following birth. When a baby is born, parents want to know that their baby is healthy. Knowing that their baby has the potential to develop breast cancer in 20-60 years would not be comforting news. I think if a child grows up,knowing they have a family history of cancer and has an interest in knowing their risk, they can elect to have a screening test.
ReplyDeleteBecause the development of breast cancer is associated with older age, young girls should not have to live in fear, wondering when and if they will get sick. For example, the youngest sister in the family of 3 girls, featured in "In the Family" shared that she felt like she was too young, like she still had time to enjoy healthy years before she had to worry about developing breast cancer. When women are older, they have the maturity to more appropriately handle the somewhat grave statistics that come with having a mutation at the BRCA 1 or 2 gene. We do not want girls' quality of life to decrease, as a result of grow up paranoid at the possibility of getting sick.
On the other hand, researchers believe that this genetic screening could potentially reduce the number of cases of breast cancer. However, knowing you have the gene, entering a surveillance program, or lowering your risk factors does not mean can prevent the disease.
While it is extraordinary that we have the potential to predict the probability an individual has of developing a disease, i think there are ethical issues that still stand between making this screening test available right after birth. The baby should have a choice to know her fait and decide to get tested on her own when she is old enough.
My initial reaction to this article and study is that information sooner does not always mean better interventions or health outcomes. I baby girl is not, and can not, have her breasts removed as soon as she finds out that she is at a genetically increased risk of developing breast cancer. She will still need to wait until she is old enough to make that kind of a decision. Having the knowledge sooner simply means that her family, and the girl herself, will be living with increased anxiety and stress until the time comes to actually make any major decisions. The article mentions that preventative measures can be taken such as healthy diet and lifestyle choices, but those should be "prevention" methods for everyone, regardless of your predisposition to breast cancer. It seems mind boggling to me that someone would need that kind of pressure to make healthy lifestyle choices. Until the girl is 18, there are no real substantial changes put forth by the article that the girl and her family could take. At the time the girl turns 18, she is more than capable and legally able to make the decision to undergo genetic testing for herself. If this were some sort of time sensitive disease that killed most of its carriers before they hit puberty then my position would be very different. However, as it stands breast and ovarian cancers are primarily cancers of middle age and "preventative" measures are simply healthy lifestyle choices that should be encouraged in everyone. I feel funds would be much better used on other health related concerns than infant genetic testing for breast cancer, especially when taking into account the emotional toll it would have on families and the girl herself when she became old enough to understand the information.
ReplyDeleteIts definitely a neat, scientific achievement that Whittemore and others were able to look at the gene variants and more accurately from birth if someone is more likely to have breast cancer.
ReplyDeleteI do think if a more cost effective model to predict breast cancer was developed then children should be screened and parents should be informed. There have been stories about people having been very scared after receiving a risk and even having trauma. However, this kind of screening can ultimately save and improve lives. For example, Linda from the film wished she had been screened earlier before she realized she had late stage cancer. She also wishes she could have received prophylactic treatment. There could be a lot of future implications and an impact on future health outcomes. For instance, branching off of Linda, if people received this information earlier, they might have more time to process the information and their options and be more willing to undergo prophylactic treatment. The same is true in Joanne’s case rather than having to think about it in her early 30’s.
Future implications of the research include perhaps doing a study on testing people early and seeing if they have a higher risk of breast cancer, versus those that only find out later that they have a high risk of developing cancer. Certain outcomes can be tested for including whether or not people wished if they had an earlier screening or a later one. Also, trait such as happiness and pleasure in life.
Now that the possibility of this screening exists, it will have a large impact on th future research and implications.
As the article suggests, knowing your risk of breast cancer can make you change your lifestyle and improve health habits.
My initial reaction to this news story is one of awe and skepticism. I think it is an exciting prospect to consider, that babies could one day be screened for the diseases that could one day endanger their lives. The article makes a good point that this would allow that person to eventually make choices about their lifestyle to minimize environmental exposures. I think this is true and also worthwhile should the screening be cost effective. Unfortunately, that's not the case at this time, and therefore I would not support such infant screenings until this changes.
ReplyDeleteIn addition, I don't think the infant breast cancer screening should be mandatory. Parents might not want to cloud one of the happiest days of their lives with the news that their newborn might get cancer someday. If the screening exists at the infant level, it can be postponed a few years until the family is more prepared and ready to handle the information.
Any advance in medical technology can be heralded as a breakthrough, and this is exactly how breast cancer screening should be viewed. It is incredible that we can now look at one or two genes in the whole genome and determine someone’s predisposition for developing cancer. Whether you are for or against screening, the ability to pinpoint one or two genes out of billions is incredible. Putting the incredible advances aside, I think people should be wary of screening their children for breast cancer, especially from birth.
ReplyDeleteScreening of children and/or newborns for this disease puts an undue burden on both the parents and the children. The parents have to be constantly worried for their children’s health, and the children will be constantly coddled by their parents, so much so that it may stop them from having a normal childhood. Parents should not have to know whether their children have a higher likelihood of developing a disease way down the line. There is nothing you can really do about it in childhood, and there is always the possibility that even if you are genetically predisposed to breast cancer you will not get the disease.
Also, screening in childhood infringes upon the autonomy of the child, especially because this is a disease that usually occurs much later in life. People should be able to choose what health information they discover about themselves, and screening for these genes should be a discussion between the parents, the doctor, and the child. There should be no screening done before the child is old enough to understand what the test is screening for, and the consequences of both getting and not getting the screening. Screening should not occur before a child can really process the information about what is happening.
The screening done nowadays is so technologically advanced that it amazes me that as a society we can figure out if a newborn carries particular genes for certain diseases. Screening newborns for breast cancer is very controversial. Newborns have no way of understanding this process; therefore, it is hard to say that by doing this we are not taking away their autonomy. Newborns in a way are non-autonomous as they cannot make decisions by themselves, but having genes screened and mapped out for a disease that they may carry should be a decision they consciously can make on their own. I still think it is very interesting that we can figure out what genes a newborn carries, which can further help prevent them from exposure that could lead to early on cases of breast cancer. The article explains this well. However, I do not think it is overall fair to the child to not have a say in the matter.
ReplyDeleteIf a cost effect screening process was developed, I do not think children should be screened. All parents informed about their child’s breast cancer risk following birth is not a reasonable way to go about parenting a child. I think it would cause major issues among the parents and create unnecessary fear. Even if the child does hold the gene for breast cancer that does not necessarily mean that that child is going to get it. Also, even if the child does end up getting breast cancer there is no way of knowing when, at what age, the child would develop the breast cancer.