Obstetricians struggling to develop a protocol for genetic screening tools in their practice will find help during a Friday morning session when two geneticists argue the best strategies for using these tests.
The John and Marney Mathers Lecture, “Genetic Screening for Everyone or Just a Selected Few,” will take place from 10:25 to 11:15 am in Ballroom D at the Austin Convention Center.
Mary Norton, MD, professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, said clinicians must have a clearly defined strategy for using genetic testing and must apply it uniformly while allowing some flexibility for patient preferences. During the session, Dr. Norton will argue in favor of a conservative approach to genetic testing.
Lee Shulman, MD, chief of clinical genetics in the Division of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine, conducts clinical and basic research on new approaches to prenatal diagnosis, and will argue in favor of a broader approach to genetic screening for pregnant women.
Dr. Norton said the irregularity of genetic testing in obstetrics today makes things confusing for clinicians.
“Should all women have access to every genetic test available, or should only high-risk women have access to just the tests that address their risks? Or should we offer some sort of combination in the middle?” asked Dr. Norton, also the David E. Thorburn, MD, and Kate McKee Thorburn endowed chair in perinatal medicine and genetics at UCSF.
The U.S. health care system further complicates matters because it doesn’t provide directives for physicians in these situations in the way a universal system in another country would.
“In other developed countries, experts and health economists determine what makes sense on a population level and that is what is rolled out,” she said. “That works really well for 95 percent of the population. There are a few who want something more or who have a problem that is missed with the basic coverage. In the United States, however, physicians must rely on their own expert opinion to make the best decisions for patients, which can be daunting when dealing with relatively novel screening tools.”
During the debate, Dr. Norton will attempt to support her position while also giving physicians enough information to develop a plan for their practices. She also reiterated the need to make exceptions for patients who are information seekers or are anxious and request testing.
“The most important thing is for providers to have a clear strategy so that in the event you have a patient that would have benefitted from a broader approach, that patient doesn’t feel like it was a random mistake,” she said. “It is totally reasonable to say that high-risk women get offered the recommended tests. The most important thing is to have a protocol for your practice so testing isn’t random or uncoordinated.”