The emerging healthcare model which is dominated by a small number of very large health systems will be characterized, in part, by in-house, sophisticated genomic and molecular lab testing by these systems. This is because these large health systems will have the capital to invest in their own "laboratories of excellence" within their system. Such is the case with Intermountain Healthcare which has its own in-house genomics laboratory called Intermountain Precision Genomics. Intermountain Health is one of the giant health systems with 37,000 employees, 22 hospitals, and more than 185 clinics. Here is the mission statement for this laboratory copied from its web site:
At Intermountain Precision Genomics in-house laboratory, experts analyze the DNA and genetic makeup of a cancer patient's tumor, enabling detection of the individual genes with errors in a person's cancer to determine treatment options. The testing is proprietary to Intermountain Healthcare, but access to it is available to oncologists anywhere. The testing serves patients with late-stage cancer who have failed in a traditional treatment method.
Intermountain Precision Genomics has just announced a plan to develop hereditary cancer gene panels (see: Intermountain Precision Genomics to develop hereditary cancer gene panels). Below is an excerpt from the article describing this new test offering:
Intermountain Precision Genomics announced...it will develop hereditary cancer gene panels. IPG...is poised to validate and launch several tests to identify disease-causing genetic variants associated with hereditary cancer syndromes.....The move follows a recent article in the Journal of Clinical Oncology that reveals an unmet need for genetic testing in women with a history of breast and ovarian cancer. The JOC article, "National Estimates of Genetic Testing in Women with a History of Breast or Ovarian Cancer," shows that fewer than one in five women with a history of breast cancer or ovarian cancer who meet specific National Comprehensive Cancer Network criteria have undergone genetic testing. Moreover, the journal notes, most have never discussed testing with a healthcare provider...."Genetic testing may be used to identify individuals previously diagnosed with cancer as well as healthy individuals who have hereditary cancer gene mutations," added Brent Hafen, who directs cancer genetic counseling for Intermountain. He added that genetic counseling in association with genetic testing allows individuals with an increased cancer risk to obtain more frequent screenings at younger ages, which leads to earlier detection and treatment.
The field of predictive genetic testing is blossoming with 23andMe as one of the pioneers in the field. The FDA is now allowing 23andMe to market tests that assess genetic risks for the following ten diseases or conditions (see: FDA Approves Marketing Of Consumer Genetic Tests For Some Conditions):
- Parkinson's disease, a nervous system disorder impacting movement
- Late-onset Alzheimer's disease, a progressive brain disorder that destroys memory and thinking skills
- Celiac disease, a disorder resulting in the inability to digest gluten
- Alpha-1 antitrypsin deficiency, a disorder that raises the risk of lung and liver disease
- Early-onset primary dystonia, a movement disorder involving involuntary muscle contractions and other uncontrolled movements
- Factor XI deficiency, a blood clotting disorder
- Gaucher disease type 1, an organ and tissue disorder
- Glucose-6-phosphate dehydrogenase deficiency, also known as G6PD, a red blood cell condition
- Hereditary hemochromatosis, an iron overload disorder
- Hereditary thrombophilia, a blood clot disorder
So, to summarize, parallel to the testing and surveillance of patient with suspected current malignant neoplasms, we now have labs providing genomic testing to identify disease-causing genetic variants associated with hereditary cancer syndromes. Not only will such testing be financially remunerative for the performing labs, it will also serve patients by allowing those with the genetic predisposition to cancer to monitor their health more closely.