Pathol­o­gists con­front chal­lenges with new molec­u­lar tests

Modern Healthcare - - THE WEEK AHEAD - —Jaimy Lee

The re­lated is­sues of health­care costs and the ap­pro­pri­ate­ness of molec­u­lar and ge­netic test­ing will be con­sid­ered by pathol­o­gists at­tend­ing the an­nual meet­ing this week of the Col­lege of Amer­i­can Pathol­o­gists.

The meet­ing, which opens Sept. 7 in Chicago, is ex­pected to draw more than 1,300 pathol­o­gists.

As ge­netic test­ing be­comes less ex­pen­sive and new re­search iden­ti­fies links be­tween gene mu­ta­tions and can­cer, pathol­o­gists face grow­ing ques­tions about when ge­netic and molec­u­lar test­ing should be used and how pa­tients should be coun­seled and in­formed. “Not all in­for­ma­tion may be ap­pro­pri­ate for a pa­tient,” said Dr. Gene Her­bek, pres­i­dent of the Col­lege of Pathol­o­gists and a pathol­o­gist at the Ne­braska Methodist Health Sys­tem.

This may be chal­leng­ing to ex­plain to pa­tients as lab­o­ra­to­ries de­velop and pro­mote new ge­netic tests. Mak­ing the is­sue more com­pli­cated are cost con- cerns. While prices for molec­u­lar test­ing have dropped sig­nif­i­cantly in re­cent years, some tests still cost thou­sands of dol­lars.

Her­bek said an ex­am­ple of an ap­pro­pri­ately used test is with the on­col­ogy drug Her­ceptin, which works only when treat­ing women with HER2­pos­i­tive breast can­cer. The drug can be highly toxic to the heart and lungs and costs up­wards of $100,000. “It’s a good ther­apy if you have the molec­u­lar marker,” he said. “We can af­ford it when it’s done for the right rea­sons.”

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