Genetic tests rise, staff struggle

Health system’s ability to cope tested

Genetic tests are being performed in such big numbers that there is a risk they will overwhelm the ability of doctors to keep up and swamp funding arrangements.

That is the view of specialists after a survey revealed the extent of DNA testing in Australia.

A total of 160,000 tests – for more than 400 medical conditions – were performed in 2006, according to the first national audit of the burgeoning field.

“We’re in transition from a cottage industry to the inclusion of genetic testing in mainstream medicine,” said Dr Graeme Suthers, who conducted the study funded by the federal Department of Health and Ageing.

About 40 per cent of the tests involved screening healthy people for genes that could cause diseases such as cystic fibrosis in their children, or screening donor tissue for compatibility in transplants or transfusions.

Twenty eight per cent were to diagnose or eliminate a genetic cause for unexplained symptoms, and 8 per cent were conducted on cancer cells to check for genetic damage. Tests on family members of people with cancer-causing gene mutations accounted for 5 per cent.

Chromosome tests on unborn children and DNA testing of microbes to identify infections were not surveyed; nor were non-medical uses like paternity tests.

Gene analysis of cancers was rising, said Dr Suthers, the head of the familial cancer unit at the South Australian Clinical Genetics Service, as evidence showed some drugs were more effective against tumours with particular genetic characteristics.

“In women with breast cancer there’s a good case for a genetic profile,” said Dr Suthers, who will present the results in Adelaide today.

Bev Rowbotham, the president of the Royal College of Pathologists of Australasia, said the survey results made a strong case to address funding for gene tests. Few tests received Medicare funding, Dr Rowbotham said, meaning patients were obliged to seek tests through overstretched genetics clinics at public hospitals, or pay for private tests.

Federal and state governments needed to find new ways to assess gene tests to determine quickly which should receive public funding, she said.

The clinical associate professor, Kristine Barlow-Stewart, also the director of the centre for genetics education at the Royal North Shore Hospital, said doctors needed more genetics training to help them decide when to order gene tests and to reassure patients that a gene mutation was usually only one factor in developing disease.

“[Doctors] talk in numbers and percentages but generally people think in black and white: I will get [a disease] or I won’t get it,” she said.

from a Sydney Morning Herald article – August 6, 2008 by Julie Robotham, Medical Editor, Sydney Morning Herald