In case you missed our excellent discussion on precision oncology with Dr. Fred Schnell and Dr. Quoc Truong this week, we thought we’d review what precision medicine means for the future care of your covered lives.

Had you been diagnosed with, for example, lung cancer ten years ago, your oncologist would have acted primarily on the visual description of the tumor under the microscope as reported by the pathologist. They would have described the tumor as either a “small cell” carcinoma (arising from “neuroendocrine” tissue), an “adenocarcinoma” (arising from glandular tissue) or a “squamous cell” carcinoma (arising from skin-like cells). Then your oncologist, depending on the size of the tumor and its spread outside the lungs to places like liver or bone, would have prescribed a regimen of chemotherapy and possibly radiation based on which broad category your tumor fit into. The chemotherapy and radiation would have had “toxicity” that limited its dose: things like nausea, a rash, low blood counts, or fever. You and your oncologist would have crossed your fingers and hoped for a tumor response.

If you were to be diagnosed now, though, as Drs. Schnell and Truong outlined, you would ideally have two crucial tests done before you ever received treatment. The first would be a “whole-genome” scan of the tumor’s DNA for specific mutations that might affect its response to specific drugs. One that was mentioned yesterday was a mutation in the epithelial growth factor gene. The second test would be another whole-genome test, this time from your blood, to see if you had any predisposition to cancer that might affect your response or your family’s risk for cancer. This would not only help you but would help your family members adopt early detection practices if you were to be found to carry an abnormal gene. The most famous of these genes, unrelated to lung cancer, are probably the “BRCA” mutations that increase the risk of breast and ovarian cancers.

Based on those tests, you would not necessarily receive the blunt, toxic chemotherapy that you would have ten years ago. You may receive one of those drugs, but the testing might indicate that you’d be a better candidate for much more precise, directed therapy, such as a drug that specifically targets the epithelial growth factor receptor or another gene mutation.

This genetic testing is not cheap. Whole-genome testing may run into the $3,000 or higher range. But given the astonishing cost of cancer chemotherapy and radiation, paying for this testing upfront seems to be a reasonable gamble if it means a less toxic, more precise, and potentially more effective therapy for a malignancy. We would love to explore this topic with you further. If you haven’t had a chance to dial into one of our oncology modules, please feel free to reach out, and we’ll get you signed up!

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.