Some women could be given the nod not to bother with mammograms as a result of advances in health informatics, says the head of the country’s largest health software firm.
Orion Health chief executive Ian McCrae said cheaper gene tests and the growing use of data in healthcare meant it might make sense for women with low-risk factors not to have the breast cancer checks.
Younger women with known genetic risks, on the other hand, could be offered alternative and safer screening options such as ultrasound checks and MRI scans, he said.
McCrae, whose company is championing advances in so-called precision medicine, made the comments prior to Tuesday’s news that Cabinet minister, Nikki Kaye, 36, had been diagnosed with breast cancer.
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Dr Reena Ramsaroop, a pathologist at Waitemata District Health Board and chairwoman of the Breast Cancer Foundation, acknowledged the value of the technologies McCrae was promoting but questioned some of the statistics and medical facts on which he based his views.
“To say that women should not be screened is not the right thing now – in the next 50 years maybe,” she said.
McCrae said: “What we have today is blanket coverage; you hit 45 and all women go into a breast screening programme, but that is a fairly coarse way of doing it.”
About 20 per cent of breast cancers could be traced to genetic factors – including about 15 per cent to the prime culprit BRCA genes – and women with dense breast tissue also had a four-to-six-times greater risk, he said.Drinking and smoking can also play a part.McCrae said he was not advocating withdrawing free mammograms for any women.
“You probably couldn’t do that because there is still a possibility. But you might decide women might opt out themselves.”
Offering alternative screening tests to young women who had genetic risks could be justified given the radiation from mammograms increased their risk of breast cancer through their lives by 90 per cent, he said.
The price of mailing a saliva sample to a US laboratory and having genes associated with breast cancer identified had fallen to just under US$1000 (NZ$1350), he said.The health system and companies such as Orion Health needed to gear up to handle the vast volumes of data that would flow from genetic and other new predictive tests, he said.
“This is what precision medicine is all about – instead of crude ‘one size fits all’, treating all women the same, once we have all this other information you can start treating women differently.”
But Dr Ramsaroop said only 5 per cent of diagnosed breast cancers could be attributed to BRCA genes, and probably less than another 5 per cent to other genetic variants.
Dense breasts were both a risk factor and harder to screen through mammography, she said.But ultrasound was not a good alternative for higher-risk women as it was not as sensitive and the problem with MRI was cost, she said. “MRI is much more expensive.”
“If women are under 30 and BRCA positive then they will be screened with MRI and not with mammograms.” The recommendation for woman between 30 and 40 was a bit “grey”.
People should be excited by improvements in health informatics, she said. “‘Big data’ is very useful telling us about disease patterns and outcomes. The problem is we know so little about the disease.”McCrae spent US$25,000 on a barrage of health tests in the US.
They included his second full genome test with “400 pages of analysis”, MRI scans and checks on his microbiome (bugs that live in the body) and metabolome (chemicals produced by the body).
“It’s curiosity but also as an organisation [Orion Health] all this stuff is arriving and we have got to be able to store it and do something with it,” he said.