Dr Sancy Leachman Discusses Tailoring Genetic Testing for Melanoma to the Patient

Each patient needs to weigh the benefits and risks of genetic testing for melanoma and have someone who can take the time to explain everything, including insurance risks, said Sancy Leachman, MD, PhD, professor and chair in the Department of Dermatology and director of the Melanoma Research Program at the Knight Cancer Institute at Oregon Health and Science University.

Transcript

After a patient gets a genetic test to understand their risk for developing melanoma, what should the next steps be for them?

It needs to be tailored for the individual. I send all of my patients who are candidates for testing to a genetic counselor, because I feel like they can spend the time to sit with them—they'll spend an hour or 2 hours sometimes—discussing the pros and the cons of getting the genetic testing, and whether or not that's something they want to go through at this time or not. They'll spend time finding out if their insurance will cover it after the testing or not, or if they're going to have to pay out of pocket. They spend the time really going through deeply through their pedigree, so that they can identify not just the melanoma genes, but let's say they had breast cancer or colon cancer, they want to put the genes that are responsible for those sort of patterns of cancer in the panel that gets tested, and they can help to identify those specific genes that need to be for sure included in the panel. That takes a lot of time.

I think that the patient is best served by having a person who can devote that time to doing a really thorough job with that and talking about the risks of insurance. In the United States, we've got GINA, the Genetic Information Nondiscrimination Act. Most states also have a nondiscrimination act. Those are very important to make sure that if you do get genetic testing, that you don't have to worry about your health insurance or your employment. It's illegal to fire you or cancel your health insurance. You can't have that happen. But you can have a problem getting life insurance or disability insurance, because those are considered more of the luxury items. They don't fall under the GINA or the nondiscrimination act for the state.

You need to make sure that you know those risks and that the knowledge that you're getting, is going to be worth it. I think that the next step is to really consider that, and to have somebody that can sit and talk to you about it and make sure that you understand what the real risks and benefits are. And I haven't talked about the benefits, but I think those are just as important. And I do think in many cases, the benefits do outweigh the risks there.