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Would You Want To Know What Disease You’ll Get?

Well ironically or not, it’s been barely a few months since I wrote about the intersection of technology and cancer and the science is already becoming commercial. Enter 23 and Me. You probably know them from that super viral Facebook Video of people getting their ancestry test and saying low-key racist things, only to find that they have ancestors from that people group. I’ll avoid the topic of agendas and what not (much easier had in person) but the interesting topic of today is of course cancer.

A single person’s DNA when unwound is roughly 2–3 meters long.

The aforementioned company has recently received FDA approval (see here) to sell you a test, allowing to know if you have a higher risk of Breast Cancer. That’s right, you can buy a test to see if you are at risk for breast cancer. Specifically they are talking about BRCA gene mutations for breast cancer. Now BRCA is actually a set of two genes which have been linked to breast cancer, especially in specific peoples groups such as Norse peoples and Ashkenazi Jews. It also has been linked to some ovarian cancers.

Though most of their methods are still proprietary, this test is still the tip of the iceberg, as it seems to be focusing only on one gene group, meaning machine learning probably doesn’t come into play much. It seems like this is a necessary first step to keep their company profitable and functioning, but I’m sure they are just watering at the mouth to start marketing the more recent discoveries I’ve read about in academia.

But like all things, there are caveats and with something as complicated as cancer, boy are the caveats big.

  1. Namely, as I’ve stated before, it is basically an accepted fact that there is unlikely to be a single, or even a few, genes which will result in the cure for cancer. If that were to happen, it would still only be for one of the hundred plus cancer types.
  2. This gives customers a RISK assessment. It is not a definitive diagnosis like “You have cancer.” 23 and Me were very particular about this because, you know, lawsuits. Risk will always exist. The question is how aware of it are you? Is more awareness good or bad? Is it neither?
  3. It doesn’t test for every single variant of BRCA just the most common ones.
  4. Just because a test comes back negative doesn’t mean you won’t get breast cancer or for that matter any cancer. Cancer can be caused just as much from environmental factors as well as hereditary.
  5. The company is not held responsible for how this affects your life (again lawsuits) and the decisions you make in your life due to these results.
  6. Also, you are basically handing over the rest of your DNA to them, including the portions not relevant to this test, for them to do as they please. Now I will say this is most likely going to be put into a library to improve science and increase the accuracy of predictions and I’m a big proponent of public databases like this for solving complex issues, but still something to consider if you are a privacy jockey.
  7. Error. Having worked with genomic data extensively, I’m well aware there is always a chance for error somewhere along the process. A result either way still has a chance of being completely inaccurate. Biology is incredibly complex and even SpaceX’s Falcon Heavy is simple when compared to human physiology, let alone genetics.
Risk will always exist. The question is how aware of it are you?

So what are the main takeaways? This may get a bit into the realm of Political Science/Law, but it is important to remember that the United States is built on precedent, beginning from the Declaration of Independence in which the primary precedents are “certain unalienable rights Endowed by Our Creator.” The FDA has set a precedent in the field as these tests can be sold to everyone commercially. The knowledge of your disease risk has become accessible and the decision of whether or not you want to peer behind the veil is your own. For cancer, it still has a ways to go, but for diseases that are most likely inherited through genetics such as Sickle Cell Anemia, Cystic Fibrosis, even Alzheimer’s the potential for such tests to be widely marketed is now open.

Science by itself loses it’s function.

It also provides an open door in terms ethical dilemmas. Do you want to know, for example, if you will die with Alzheimer’s, losing all semblance and memory of who you were? Should the knowledge of risk to human well-being be sold and marketed? We can never separate ethics and morality from science. It is dangerous to do so and we must remember our past, including the Nazi Nuremberg Trials. Though many may avoid thinking about such philosophical topics, I am of the belief that it is essential to being human and a part of modern society. As artificial intelligence progresses and the limits of what we can do with medicine expands, we must not forget what makes humanity humanity, whether that entails all our triumphs and all our failures. I’m curious to see which one this becomes.

Chris is currently working on several publications regarding the use of genetic and epigenetic information in various cancer prediction modalities.

Disclaimer: Chris has no ties our stock-holdings in 23 and Me.

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Thanks !

Thanks for sharing this, you are awesome !

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