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Before or After?

Health insurers and some clinicians are at odds over whether women at high risk of developing breast cancer should seek genetic counseling before undergoing genetic testing, NPR reports.

US insurers like UnitedHealthcare and Cigna require women to undergo counseling from a genetic counselor or cancer genetics professional prior to ordering BRCA testing, NPR says. UnitedHealthcare began requiring pre-test counseling in January, and NPR notes that physicians can perform the counseling if they indicate they are qualified to do so. Likewise, physicians who've undergone additional cancer genetics training meet Cigna's counseling requirement.

Some obstetrician-gynecologists, though, argue that this added step of pre-test counseling would dissuade some women from seeking testing, according to NPR. In addition, they say that they as physicians counsel patients about hereditary cancer and prenatal genetic testing as part of their regular patient visits. Genetic counselors, Mark DeFrancesco, the past president of the American Congress of Obstetricians and Gynecologists, says, have a key role — but after testing has occurred.

Mary Freivogel, the president-elect of the National Society of Genetic Counselors, tells NPR that testing can be complex.

"Not everybody has a set of family members that allow for the elevated risk to be obvious," adds Robert Smith, a cancer epidemiologist at the American Cancer Society. "There's a lot to be said for having a specialist do it."