A woman in her 20s was concerned about her risk for breast cancer because her mother had previously had it. She saw a medical oncologist and wanted to be tested to see if she had inherited any pathogenic genetic variants that could increase her risk for developing breast cancer. The oncologist ordered a genetic test panel that assessed a couple dozen genes mainly associated with breast, gynecologic, and colorectal cancers from a well-regarded lab.
The patient’s insurance company required evaluation by a genetic counselor to determine if genetic testing was “medically necessary” before covering it. The test requisition form, which had been shared with the genetic counselor, indicated that the doctor had ordered testing for a patient who did not have cancer but whose mother did, but her mother was still living and had not yet been tested. And while the patient was concerned about her family’s experience with cancer, the genetic counselor did not find it to be very striking – the patient’s mother was not particularly young when she got breast cancer, in her 50s, and there weren’t multiple cancer diagnoses in the extended family.
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