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• What is gene testing?
• What are some of the pros and cons of gene testing?
• For what diseases are gene tests available?
• Is genetic testing regulated?
• Does insurance cover genetic testing?
• Testing recommendations
• More Information

Gene tests (also called DNA-based tests), the newest and most sophisticated of the techniques used to test for genetic disorders, involve direct examination of the DNA molecule itself. Other genetic tests include biochemical tests for such gene products as enzymes and other proteins and for microscopic examination of stained or fluorescent chromosomes. Genetic tests are used for several reasons, including:

carrier screening, which involves identifying unaffected individuals who carry one copy of a gene for a disease that requires two copies for the disease to be expressed preimplantation genetic diagnosis (see the side bar, Screening Embryos for Disease) prenatal diagnostic testing newborn screening presymptomatic testing for predicting adult-onset disorders such as Huntington's disease presymptomatic testing for estimating the risk of developing adult-onset cancers and Alzheimer's disease confirmational diagnosis of a symptomatic individual forensic/identity testing

Screening Embryos for Disease Preimplantation genetic diagnosis (PGD) is a test that screens for genetic flaws among embryos used in in vitro fertilization. With PGD, DNA samples from embryos created in-vitro by the combination of a mother's egg and a father's sperm are analyzed for gene abnormalities that can cause disorders. Fertility specialists can use the results of this analysis to select only mutation-free embryos for implantation into the mother's uterus. Before PGD, couples at higher risks for conceiving a child with a particular disorder would have to initiate the pregnancy and then undergo chorionic villus sampling in the first trimester or amniocentesis in the second trimester to test the fetus for the presence of disease. If the fetus tested positive for the disorder, the couple would be faced with the dilemma of whether or not to terminate the pregnancy. With PGD, couples are much more likely to have healthy babies, Although PGD has been practiced for years, only a few specialized centers worldwide offer this procedure.

In gene tests, scientists scan a patient's DNA sample for mutated sequences. A DNA sample can be obtained from any tissue, including blood. For some types of gene tests, researchers design short pieces of DNA called probes, whose sequences are complementary to the mutated sequences. These probes will seek their complement among the three billion base pairs of an individual's genome. If the mutated sequence is present in the patient's genome, the probe will bind to it and flag the mutation. Another type of DNA testing involves comparing the sequence of DNA bases in a patient's gene to a normal version of the gene. Cost of testing can range from hundreds to thousands of dollars, depending on the sizes of the genes and the numbers of mutations tested.

Gene testing already has dramatically improved lives. Some tests are used to clarify a diagnosis and direct a physician toward appropriate treatments, while others allow families to avoid having children with devastating diseases or identify people at high risk for conditions that may be preventable. Aggressive monitoring for and removal of colon growths in those inheriting a gene for familial adenomatous polyposis, for example, has saved many lives. On the horizon is a gene test that will provide doctors with a simple diagnostic test for a common iron-storage disease, transforming it from a usually fatal condition to a treatable one.

Commercialized gene tests for adult-onset disorders such as Alzheimer's disease and some cancers are the subject of most of the debate over gene testing. These tests are targeted to healthy (presymptomatic) people who are identified as being at high risk because of a strong family medical history for the disorder. The tests give only a probability for developing the disorder. One of the most serious limitations of these susceptibility tests is the difficulty in interpreting a positive result because some people who carry a disease-associated mutation never develop the disease. Scientists believe that these mutations may work together with other, unknown mutations or with environmental factors to cause disease.

A limitation of all medical testing is the possibility for laboratory errors. These might be due to sample misidentification, contamination of the chemicals used for testing, or other factors.

Many in the medical establishment feel that uncertainties surrounding test interpretation, the current lack of available medical options for these diseases, the tests' potential for provoking anxiety, and risks for discrimination and social stigmatization could outweigh the benefits of testing.

For more information, see:

• Genes, Dreams, and Reality: The Promises and Risks of the New Genetics - Article from Judicature.
• What Can the New Gene Tests Tell Us? - Article from the Judges' Journal of the American Bar Association.
• Bridging the Gap Between Life Insurer and Consumer in the Genetic Testing Era - Article from the Indiana Law Journal.

Currently, more than 1000 genetic tests are available from testing laboratories. Some gene tests available in the past few years from clinical genetics laboratories appear below. Test names and a description of the diseases or symptoms are in parentheses. Susceptibility tests, noted by an asterisk, provide only an estimated risk for developing the disorder. Contact GeneTests for comprehensive information on test availability and genetic testing facilities.

• Alpha-1-antitrypsin deficiency (AAT; emphysema and liver disease)
• Amyotrophic lateral sclerosis (ALS; Lou Gehrig's Disease; progressive motor function loss leading to paralysis and death)
• Alzheimer's disease* (APOE; late-onset variety of senile dementia)
• Ataxia telangiectasia (AT; progressive brain disorder resulting in loss of muscle control and cancers)
• Gaucher disease (GD; enlarged liver and spleen, bone degeneration)
• Inherited breast and ovarian cancer* (BRCA 1 and 2; early-onset tumors of breasts and ovaries)
• Hereditary nonpolyposis colon cancer* (CA; early-onset tumors of colon and sometimes other organs)
• Central Core Disease (CCD; mild to severe muscle weakness)
• Charcot-Marie-Tooth (CMT; loss of feeling in ends of limbs)
• Congenital adrenal hyperplasia (CAH; hormone deficiency; ambiguous genitalia and male pseudohermaphroditism)
• Cystic fibrosis (CF; disease of lung and pancreas resulting in thick mucous accumulations and chronic infections)
• Duchenne muscular dystrophy/Becker muscular dystrophy (DMD; severe to mild muscle wasting, deterioration, weakness)
• Dystonia (DYT; muscle rigidity, repetitive twisting movements)
• Emanuel Syndrome (severe mental retardation, abnormal development of the head, heart and kidney problems)
• Fanconi anemia, group C (FA; anemia, leukemia, skeletal deformities)
• Factor V-Leiden (FVL; blood-clotting disorder)
• Fragile X syndrome (FRAX; leading cause of inherited mental retardation)
• Galactosemia (GALT; metabolic disorder affects ability to metabolize galactose)
• Hemophilia A and B (HEMA and HEMB; bleeding disorders)
• Hereditary Hemochromatosis (HFE; excess iron storage disorder)
• Huntington's disease (HD; usually midlife onset; progressive, lethal, degenerative neurological disease)
• Marfan Syndrome (FBN1; connective tissue disorder; tissues of ligaments, blood vessel walls, cartilage, heart valves and other structures abnormally weak)
• Mucopolysaccharidosis (MPS; deficiency of enzymes needed to break down long chain sugars called glycosaminoglycans; corneal clouding, joint stiffness, heart disease, mental retardation)
• Myotonic dystrophy (MD; progressive muscle weakness; most common form of adult muscular dystrophy)
• Neurofibromatosis type 1 (NF1; multiple benign nervous system tumors that can be disfiguring; cancers)
• Phenylketonuria (PKU; progressive mental retardation due to missing enzyme; correctable by diet)
• Polycystic Kidney Disease (PKD1, PKD2; cysts in the kidneys and other organs)
• Adult Polycystic Kidney Disease (APKD; kidney failure and liver disease)
• Prader Willi/Angelman syndromes (PW/A; decreased motor skills, cognitive impairment, early death)
• Sickle cell disease (SS; blood cell disorder; chronic pain and infections)
• Spinocerebellar ataxia, type 1 (SCA1; involuntary muscle movements, reflex disorders, explosive speech)
• Spinal muscular atrophy (SMA; severe, usually lethal progressive muscle-wasting disorder in children)
• Tay-Sachs Disease (TS; fatal neurological disease of early childhood; seizures, paralysis)
• Thalassemias (THAL; anemias - reduced red blood cell levels)
• Timothy Syndrome (CACNA1C; characterized by severe cardiac arrhythmia, webbing of the fingers and toes called syndactyly, autism)

Is genetic testing regulated?

Currently in the United States, no regulations are in place for evaluating the accuracy and reliability of genetic testing. Most genetic tests developed by laboratories are categorized as services, which the Food and Drug Administration (FDA) does not regulate. Only a few states have established some regulatory guidelines. This lack of government oversight is particularly troublesome in light of the fact that a handful of companies have started marketing test kits directly to the public. Some of these companies make dubious claims about how the kits not only test for disease but also serve as tools for customizing medicine, vitamins, and foods to each individual's genetic makeup. Another fear is that individuals who purchase such kits will not seek out genetic counseling to help them interpret results and make the best possible decisions regarding their personal welfare. More information on these questionable test kits is available from Dubious Genetic Testing, an online report provided by Quackwatch. For a brief overview of the current regulatory environment for genetic testing, see the Oversight of Genetic Testing, a Genetics Brief from the National Conference of State Legislatures.

Does insurance cover genetic testing?

In most cases, an individual will have to contact his or her insurance provider to see if genetic tests, which cost between $200 and $3000, are covered. Usually insurance companies do not cover genetic tests, those that do will have access to the results. Insured persons would need to decide whether they would want the insurance company to have this information. States have a patchwork of genetic-information nondiscrimination laws, none of them comprehensive. Existing state laws differ in coverage, protections afforded, and enforcement schemes. The National Conference of State Legislatures provides a listing of current legislation regarding genetic information and health insurance. The recent marketing of genetic test kits directly to consumers, may lead to an increase in demand for insurance coverage. See the Genetics and Health Insurance (PDF) policy brief from the National Conference of State Legislatures for more information.

Testing Recommendations

• Secretary's Advisory Committee on Genetic Testing - Access documents about oversight of genetic testing, genetic discrimination legislation, gene patenting and searching, and secondary subjects.
• Exec. Summary of Working Group on Genetic Testing for Breast Cancer Susceptibility - From the Stanford Program in Genomics, Ethics, and Society.
• Promoting Safe and Effective Genetic Testing in the United States - Final report of the Task Force on Genetic Testing created by the National Institutes of Health-Department of Energy Working Group on Ethical, Legal, and Social Implications of Human Genome Research. Published September 1997.

More Information

Educational Modules

• GeneTests Web Site
• Understanding Gene Testing - A tutorial that illustrates what genes are, explains how mutations occur and are identified within genes, and discusses the benefits and limitations of gene testing for cancer and other disorders. From the National Cancer Institute.
• Genetic Testing of Newborn Infants - An activity for considering government policies to guide a program for genetic screening of newborns. From the Genetic Science Learning Center.
• Understanding Gene Testing - A basic introduction to genes and genetic testing from the U.S. Department of Health and Human Services.

Ethical, Legal, and Social Issues

• Ethical, Legal, and Social Issues of the Human Genome Project
• Prenatal Testing: A Modern Eugenics? - From the DNA Files provided by National Public Radio (NPR).
• Genetic Testing for Inherited Predisposition to Breast Cancer - An article from the National Breast Cancer Coalition web site - April 2003
• Online NewsHour: Genetic Testing - NewsHour with Jim Lehrer Transcript from June 2001 describing how a company secretly ran genetic tests on employees without telling then or obtaining their permission.
• Clairvoyance and Caution - A chapter written by Nancy Wexler about the issues associated with undergoing a predictive test when no prevention or cure exists. From the book The Code of Codes [edited by Daniel Kevles and Leroy Hood. Harvard University Press, 1992].

Related Policy and Legislation

• American Academy of Actuaries - Issue Brief: The Use of Genetic Information in Disability Income and Long-Term Care Insurance
• American Academy of Actuaries - Issue Brief: Genetic Information and Voluntary Life Insurance
• Resources from the National Conference of State Legislatures
  • Policy Briefs: Current Genetics Issues of the Day - Brief reports on privacy; testing; health insurance; life, disability, and long-term care insurance; newborn genetic screening; legislative activity; chronic disease; cost-effectiveness; oversight; and tandem mass spectrometry.
  • State Genetic Nondiscrimination in Health Insurance Laws
  • Genetics and Life, Disability, and Long-term Care Insurance
  • State Genetic Privacy Laws
  • State Genetics Employment Laws
  • Newborn Genetic and Metabolic Disease Screening
  • Newborn Genetic Screening Privacy Laws

Other Resources

• Aetna Recommends Guidelines for Access to Genetic Testing - Company advocates education and information privacy
• Evaluating Gene Testing - Information on evaluating test quality, the potential usefulness of test results, available preventive or treatment options, and social issues. From the Human Genome Project Information Web site.
• GeneTests - Find reviews of genetic disorders, genetics glossary, clinics, and laboratories conducting gene testing.
• Genetic Testing - A collection of news, overviews, and other Web resources from MEDLINEplus.
• Genetic Testing - An introduction to genetic testing and the different types of tests available. From the Genetics & Public Policy Center.
• Human Gene Testing - An article on gene testing and science behind genetic disorders from the National Academy Sciences Beyond Discovery™ series that traces the origins of important recent technological and medical advances. Published in 1996.
• If Genetic Tests Were Available for Diseases Which Could Be Treated or Prevented, Many People Would Have Them - A report on the results of a poll conducted in 2002 by Harris Interactive.
• Human Genetic Testing & DNA Analysis - A collection of Web sites and recorded broadcasts of radio programs. From the DNA Files provided by National Public Radio (NPR).
• Cancer Genetics - A collection of resources on genetic testing for cancer. From the National Cancer Institute.

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