Genetics-based breast cancer screening: Are lower costs worth ‘the horrendous psychological toll’?

After a JAMA Oncology report suggested earlier this month that around a third of women might benefit from avoiding breast cancer screening altogether, one Guardian editorialist is warning women of the psychological toll that can come hand-in-hand with genetic screening.

Breast cancer guidelines in the U.K. suggest early screening can save around 1,300 lives a year, Fay Schopen, a BRCA2 carrier and breast cancer survivor herself, wrote in the Guardian. Women between 50 and 70 years old are invited for mammograms every three years, and that’s been standard protocol for a long time. If the NHS switches to a genetic screening system, only the top 70 percent of those women with the greatest risk for developing breast cancer would be called for screening, potentially avoiding an overdiagnosis problem.

“Given the principle that what gets measured gets managed, some women who are screened are diagnosed and treated for breast cancer that would never otherwise have caused them harm,” Schopen wrote. “The horrendous psychological toll cannot be measured as easily as taking an x-ray of a breast.”

Schopen, whose mother died of the disease at 35, worked to get into an early screening program but found she balked at the chance to undergo genetic testing.

“Sure, it sounds rational,” she wrote. “It’s just fact-finding, after all. But in your own body, delving into the myriad dark and hidden ways your treacherous genes can and will betray you.”

The stakes are high, Schopen said, and genetic testing often leads to difficult decisions for young women, like whether or not to have a preventive double mastectomy in your thirties. The psychological toll genetic screening can take could result in a greater need for therapists, support groups, psychiatrists—all things that would mean more spending on the NHS’s part.

“We must surely accept the notion of the greater good here,” Schopen wrote. “Efficiency in terms of NHS spending, in terms of lives saved. But we are potentially swapping a small psychological toll for the many for a greater psychological toll for the few—and unpicking this is going to amount to more than some accountant-friendly statistics about costs and benefits.”

Read the full editorial at the link below.