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this post was submitted on 04 May 2025
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The arrogance of some doctors can be scary. I used to be a clinical genetic counselor, a job specifically designed to focus on working with doctors as a genetics specialist so that they don't need to know all the intricacies of that on top of everything else. Most doctors I worked with hated me, and saw me as a distraction from work they could handle on their own.
One time a doctor went over my head to order a genetic test for a patient who had a very strong family history of breast cancer. He didn't refer her for a genetic counseling session, which was the protocol so that we could explain to her her own risk and the potential positive result, and give her the option to make an informed choice about whether or not she wanted testing at all. He just offered her the test out of the blue and, not really knowing what it meant, she just accepted by default. Not only did she test positive for a BRCA1 mutation, increasing her lifetime risk of developing breast cancer to over 90%, but the doctor incorrectly interpreted the results of the test, and believed she tested positive for breast cancer itself.
I only learned about the patient because the doctor mentioned her nonchalantly during a review meeting, and I had to correct him about the results of the test and convince him to refer her to me. I think the only reason he agreed was because he was put on the spot in front of the whole oncology department. I was lucky that the doctor hadn't yet incorrectly reported to the patient that she had breast cancer, but I still had to inform this woman, who barely understood why she was here, that she'll likely want to start scheduling yearly mammograms right now, or even consider a mastectomy, while she was still in college. That was the most difficult day of my short time in the field, and a big reason for why I ultimately left.
That's... not true, at least not in 2017 when this happened. Yes, a double mastectomy is an available option, and is the one most commonly taken due to the high risk, but another option, at least in the US at the time, is to have yearly mammograms. Often women want to keep their breasts until they have children and get through breastfeeding, then have a double mastectomy as well as an oophorectomy due to the high ovarian cancer risk that also comes with a BRCA1 mutation. I haven't kept up with recommendations since leaving the field in 2019, but at least back then, there were more than one option, and I'd be surprised if it's been constricted to a forced double mastectomy since then.
Ah, you're talking about the news story. Sorry, since you replied to my comment, I thought you were talking about the story I shared, which is of a different person. The woman from the news story wasn't diagnosed with a familial cancer condition like a BRCA mutation. Also, it's important to note that while a double mastectomy would definitely be recommended in the case of a BRCA1 mutation, ultimately the patient obviously gets the final decision on what they go with. It's important to offer it, of course, but it's not something to be forced on a person, regardless of the benefits. People have more going on in their life than what a doctor sees in their office, and can sometimes have something of even greater importance going on at the moment. Treatment is always a discussion to have with the patient, not a decision made on their behalf.