Should Cancer Gene Screening Be Population-Based?

This transcript has been edited for clarity. 
Hello. I’m Dr Maurie Markman, from City of Hope. I’d like to speak for the next few minutes on a very interesting modeling study that was recently published in JAMA Network Open, entitled, “Cost-Effectiveness of Population-Based Multigene Testing for Breast and Ovarian Cancer Prevention.” 
This is a very complex topic. There are two thought camps here in this area. One is, if a woman develops breast cancer and has a family history of breast cancer, that’s when we should consider the use of testing of her entire family to look for potential for a genetic abnormality.
The alternative model that has been proposed is to say that family history isn’t very good. We may not pick this up. People may not know their family history very well. They certainly may not know it in detail. Therefore, we should do this at a population level, meaning all women, given the option, when they reach a certain age, can be tested to see if they have a pathogenic or possibly pathogenic variant, which would obviously lead to much further conversation, including screening in a very different manner and maybe even prophylactic surgery.
The cost of these strategies is obviously different. The cost-effectiveness is very different. The potential benefits are very different. Obviously, what we’re talking about here is modeling this, and looking at all the potential costs, etc. 
This analysis concluded that in almost any scenario they looked at, including doing a variety of sensitivity analyses, it was more cost-effective to do the population-based screening.
Again, women don’t have to go through the screening, but it would be recommended and presumably insurance companies would pay for it. Obviously, this would lead to some women with abnormalities and changing their strategies. The bottom line was that, in terms of the cancers that would be detected and the cost, this would be cost-effective as long as the cost of the multipanel genetic testing was $825 or less. 
This is actually very interesting because this is a point that we can look at. If one accepts this analysis and we can get this testing done well at that level of cost, is this something that we might, as a society, including insurance companies and Medicare, consider?
This is a very interesting conversation. Certainly, there is no answer at the moment. Let me emphasize that this is a model here, but I think it really does bring up the question. With hard data, again, these are modeling data, what might be the best approach moving forward in terms of the question of identifying women at germline risk for breast and ovarian cancer.
I thank you for your attention and encourage you to read this very interesting paper if you’re interested in this particular topic.