To test, or not to test? On Wednesday, employees at a slew of companies and tech firms, from SurveyMonkey to the grocery delivery service Instacart, gained cheap access to a new genetic test for breast and ovarian cancer. Color Genomics, a California-based startup, revealed a first-of-its-kind deal to work directly with 18 companies to offer its test to any employee as a perk outside of traditional health insurance.
Visa, Slack, the NBA's Sacramento Kings and the venture capital firm Andreessen Horowitz are among those that signed on and will pay at least half the cost for employees to be screened. The saliva test, which looks for mutations on 19 genes, normally costs $249, so employees at those companies will be able to buy it for $125 or less.
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Many companies offer coverage of genetic screenings for high-risk women, based primarily on family history. In fact, the Affordable Care Act requires all insurers to provide coverage for genetic tests and counseling to these women. But since about 50 percent of people who have a mutation on two genes, BRCA 1 and BRCA 2, that have been associated with breast cancer have no family history of the disease, a significant portion of those at risk do not currently have coverage.
Elad Gil, CEO and co-founder of Color Genomics, says the company’s goal under the new program is to provide access to genetic testing for every woman who might be interested in knowing her status. By negotiating directly with employers, Color Genomics circumvented the challenge of earning coverage through major insurers for women regardless of family history, though Gil says that is still the company’s long-term goal.
“This is really about choice and access, fundamentally,” he says.
However, genetics is still in its infancy and these mutations remain relatively rare, so experts say it’s not immediately clear that testing everyone is beneficial. Women who receive an alarming result may experience anxiety or even choose to undergo preventive surgery such as a mastectomy without ever being diagnosed with cancer. The National Cancer Institute says most experts agree that only people who have a family or individual history of cancer should be tested. The American Cancer Society echoes that advice. Gil says the company offers no direct recommendation, but points to a JAMA article that suggests every woman over the age of 30 should be screened.
Anya Prince, a public policy researcher who specializes in genetics at the University of North Carolina at Chapel Hill, says even those who test positive may experience unnecessary panic because they are not destined to develop cancer based merely on their genetics.
“To me it just feels early to offer this to everybody,” she says. “We're missing a lot of information about genetic variants that might help to offset the risks that might be seen. There’s just a lot that's unknown.”
Etti Baranoff, a finance and insurance expert at Virginia Commonwealth University, also questions whether the program is truly valuable to employees or companies.
“I have an ethical problem here. What good it will do and why employers are supporting it unless there is something to be done with it?” she says. "This is knowledge that can put you in such a state of anxiety.”
The test must be ordered by a physician, and Color Genomics provides genetic counseling to accompany each result. The company says employers will only know how many employees have been tested but not which employees have used the service, and will not have access to the test results.
Color Genomics also said it will visit the headquarters of any of the 18 participating companies to host educational sessions about the genetic tests for employees during work hours, and hopes to recruit more companies to join the program. The arrangement is in line with the growing role of employers in shaping employees’ health through corporate-sponsored wellness programs and on-campus health screenings.
“I think the most important thing is that people who participate in this realize that there’s still a lot we don't know and that in some ways, they're helping move that research forward by participating in these programs,” Prince says.
Gil previously served as a vice president of corporate strategy for Twitter and founded Google’s mobile division. He is active in Silicon Valley and has invested or advised at least one company that signed on to the new initiative -- the mobile payment company Stripe -- and is an active user of another, AngelList. He says Color Genomics now employs about 40 people but neglected to provide sales figures or the number of tests ordered since it launched in April.