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.
My 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.
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.
My 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.
While 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.
My 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.
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.
I 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.
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.
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."
ReplyDeleteNewborn 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.
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.
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.
ReplyDeleteI 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!
DeleteLike 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.
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.
ReplyDeleteAt 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.
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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.
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.