TIME Cancer

Here’s the Amount of Exercise That Lowers Breast Cancer Risk

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A new study calculates how much weekly exercise can reduce fat levels enough to lower the chances of developing breast cancer

More than 100 studies have found that physical activity can lower breast cancer risk; the most active women tend to have a 25% lower chance of developing the disease than the least active women. But how does exercise help?

Christine Friedenreich, scientific leader of cancer epidemiology and prevention research at Alberta Health Services, and her colleagues had identified body fat as a possible pathway to lowering cancer risk. In an earlier study, they found that women exercising 225 minutes a week showed dramatic drops in total body fat, abdominal fat and other adiposity measures.

MORE: New Genetic Test for Breast Cancer Would Be Cheaper and Easier

That inspired the team to examine more closely the effects of the commonly recommended 150 minutes of moderate to vigorous exercise a week on body fat measures. They compared these effects to a doubling of that amount of activity, to 300 minutes a week, to see if more exercise had a greater effect in lowering body fat.

Reporting in JAMA Oncology, Friedenreich found that indeed, among 384 non-active women past menopause, some of whom were normal weight and others who were overweight or obese, those randomly assigned to exercise for 300 minutes a week over the year-long study lost more body fat than those who were active for 150 minutes each week. The women didn’t change their diet or any other aspect of their lives; they just exercised their allotted amount, by walking, running, cycling or using an elliptical machine or treadmill.

MORE: Many Breast Cancer Patients Get Unnecessary Radiation

Overall, the women exercising 300 minutes weekly lost 1 kg—about 2.2 pounds—or 1% more body fat than those in the 150 minute group. The former also lost more abdominal fat and had a bigger drop in their waist to hip ratio. They did not, however, lose significantly more weight.

That last finding is important because many physical activity and cancer studies focus on weight as an outcome and correlate pounds lost with cancer risk. But Friedenreich wanted to specifically tease apart what physiologic effects exercise has on the body, specifically on fat, since fat levels have been linked to a higher risk of a number of cancers, including breast cancer.

MORE: Here’s How Well Your Genes Can Predict Your Breast Cancer Risk

While the women who exercised more saw the biggest drops in their body fat measures, those who followed the recommended amount of activity—150 minutes each week—also melted away some of their fat. But the finding suggests that more is better, and for preventing cancer, it may take more than the recommended amount of exercise to produce a benefit.

“The exercise guidelines were developed with [heart disease] outcomes in mind,” says Friedenreich. “So at that level, they can have an effect on blood pressure, cholesterol levels and waist circumference. But for cancer prevention, we may need to exercise at higher volumes. So yes, doing 150 minutes of activity a week is good, but if you can do more, then from a cancer prevention perspective, 300 minutes is better.”

The fact that exercise can lead to a drop in body fat is especially important for cancer of the breast, she says, since fatty tissue is the primary source of hormones that can drive breast cancer after menopause. Fat also plays a role in the body’s immune and inflammatory responses, both of which are also involved in cancer. “I’m sure that doctors are advising their patients to be more physically active to prevent heart disease or diabetes,” says Friedenreich. “So we’d like to add cancer to that list of chronic diseases that exercise can potentially prevent or help to lower the risk.”

TIME Cancer

Why Breast-Cancer Survivors Gain More Weight

Tumors and treatment may make it easier to put on pounds, and the latest research shows why breast cancer patients should be aware of the dangers of gaining too much

Studies have hinted that breast cancer survivors tend to gain weight after their diagnosis and treatment, but it’s not yet clear why. Because breast cancer rates tend to rise around menopause, doctors weren’t sure whether the weight gain was part of normal aging and changes in women’s reproductive status, or whether something about cancer made patients more vulnerable to gaining weight.

In a new study published in Cancer Epidemiology, Biomarkers & Prevention, researchers compared a group of women who survived breast cancer with a similar group of women who did not have the disease. All women were at higher risk of developing breast cancer because of family history. The scientists found that even after they adjusted for the influence of age, menopause and other factors, those who survived breast cancer did indeed gain more weight—almost four pounds more, on average, within five years of their diagnosis compared to those who didn’t have cancer. Among these women, those who were treated with chemotherapy were twice as likely to gain weight—about 11 pounds more, on average—compared to women who were treated with hormone-based therapies (who did not get any heavier with their treatments) and women who didn’t have cancer.

MORE: New Genetic Test for Breast Cancer Would Be Cheaper and Easier

While weight has been implicated in possibly playing some role in certain cancers, this study is among the first to tease apart what effect cancer itself, and treatments for cancer, might have on changing metabolism, inflammation, the immune system and other body functions to make weight gain more likely. By following the women for four years, the researchers, led by Dr. Kala Visvanathan, director of clinical cancer genetics and prevention service at the Johns Hopkins Kimmel Cancer Center, compared their weight changes from diagnosis onward. The team is planning to continue to follow the women for a longer period of time to track other patterns in weight.

“Obviously treatment [for the cancer] is a priority,” says Visvanathan. “But these findings show that it’s also important to take note of weight changes, especially for women getting chemotherapy. Chemotherapy treatment usually goes for six months or a year, so monitoring weight in that time and taking steps to intervene if weight is clearly increasing is important.”

MORE: Breast Cancer May Increase 50% By 2030

Many cancer patients become less active during chemotherapy, and for good reason—the regimen can be punishing on the body, leaving people feeling fatigued and less energetic. But maintaining a healthy diet and staying physically active, says Visvanathan, are critical to keeping weight down. Weight may play a role in how people respond to cancer treatments, as well as their recovery, so it makes sense to for cancer survivors to try not to gain too much.

In addition, getting heavier is associated with a higher risk of other chronic diseases. And the fact that more cancer patients—particularly breast cancer patients—survive their disease is another important reason to keep weight in check. “Most breast cancer survivors will survive their cancer for years or even decades, and die of other diseases,” says Amy Gross, a PhD candidate in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, and a co-author of the paper. “Our study highlights the need to be aware of the impact of weight gain on the risk for other diseases. It’s a problem we need to pay more attention to, in addition to just helping patients survive the cancer.”

TIME toxins

DDT Exposure During Pregnancy Linked To Breast Cancer

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DDT has previously been linked to Alzheimer’s disease, obesity and kidney and ovarian diseases

Women who had been exposed to higher levels of the pesticide DDT while in utero face increased risk of breast cancer later in life than those who were exposed to lower levels, according to new research.

Researchers evaluated 54 years of data from women starting from the time they were in utero. Out of 9,300 women who had been tracked from even before birth, the study authors identified 118 women who had been diagnosed with breast cancer. Women whose mothers had been exposed to significant levels of DDT during pregnancy were four times as likely to have had breast cancer as their counterparts who had been exposed to a small quantity of the pesticide, according to the findings.

The research, published in the Journal of Clinical Endocrinology & Metabolism, shows “direct evidence” that higher DDT exposure in utero places women at increased risk of breast cancer, said study author Barbara Cohn, PhD, a researcher at the Public Health Institute in Berkeley, CA, in a press release.

“Environmental chemicals have long been suspected causes of breast cancer, but until now, there have been few human studies to support this idea,” she said.

The United States has banned DDT, one of the first known endocrine disruptors, since the 1970s. Still, many potentially affected women who were born that era are just reaching the age when they are at increased risk for breast cancer. Despite research that has found many health risks of DDT—the pesticide has been linked to Alzheimer’s disease, obesity, and kidney and ovarian diseases—some countries still use the chemical to fight malaria. The study authors say policymakers should consider the study as they evaluate whether to continue using DDT.

TIME Cancer

Researchers Grow a Breast In a Dish

Technically, it’s breast tissue but it develops in a lab culture the same way it would in a teen hitting puberty. And it could help scientists to better understand how the breast develops and what happens when things go awry in breast cancer

For the first time, scientists have taken healthy breast cells from women and isolated the stem cells that can recreate major breast structures—including the milk-feeding ducts and structures that actually produce breast milk. In a new paper in the journal Development, they report that they’ve set up a model for studying how normal breast tissue develops during puberty, and, in coming months, expect to introduce mutations in these cells to study how they might develop cancer.

Starting with breast tissue from women who have had breast reduction surgery, Dr. Christina Scheel, from the Helmholtz Center for Health and Environmental Research, and her colleagues managed to isolate the few stem cells within them that are responsible for generating the new breast tissue that results in the breast’s constant remodeling during puberty, at each menstrual cycle and with each pregnancy.

Only one in about 2,000 of these cells are stem cells, but by mixing up a more nurturing culture solution, they were able to increase the growth of these cells by five-fold, and before their eyes the cells began to form the branchlike structures that serve as the duct network of the breast. With other adjustments, Scheel was also able to promote the growth of the cluster-like cells that produce milk. By labeling the initial stem cell, they saw that all of the complex structures in the breast remarkably arose from a single cell, guided by the right developmental instructions.

“[During puberty,] the normal breast tissue grows [aggressively] into the surrounding connective tissue,” says Scheel. “The cells push forward into the surrounding tissue almost like an invasive tumor but in a very controlled process.”

The fact that the normal breast tissue growth is so intense is leading Scheel to next study whether breast cancer might result from some loss of this very controlled regulation of breast tissue growth, similar to a car without brakes.

She and her team also found that when they grew the breast stem cells on a more rigid platform, the cells grew more aggressively and acted more tumor-like compared to when they were grown on a more flexible, softer framework. That may explain why women with dense breasts, which contain more connective tissue, tend to have higher rates of breast cancer. “This model will allow us to better study normal breast development, and then to understand the first steps that predispose women to developing tumors,” she says.

TIME Cancer

Why Women With Dense Breasts May Not Need More Screening

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The debate over how much screening women with dense breasts should get continues

For several years now, there been a growing push to advise women with dense breast tissue to get more than just an annual mammogram. And there’s good reason for it—studies show that dense breast tissue can mask small potential tumors on a mammography image, and dense breast tissue may also be a risk factor for breast cancer.

But the latest study shows that not all women with dense breasts may be at higher risk of cancer. In a report published in the Annals of Internal Medicine, Dr. Karla Kerlikowske, professor of medicine and epidemiology/biostatistics at the University of California San Francisco, and her colleagues provide much-awaited data on exactly what the risk of cancer is for these women.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

The researchers studied 365,426 women 40 to 74 years old who had more than 831,000 mammograms total. They also had information on the number of breast cancer cases among the women within 12 months of their mammogram. When the team then applied different models for predicting which women would develop cancer—including just their dense breasts, or combinations of their dense breasts and evaluations of their five-year breast cancer risk with factors such as their age, race, family history of the disease, recent breast biopsy and breast density—they found that breast density alone was not a good indicator of cancer risk.

Dense breast tissue is determined by radiologists reading a mammogram and is relatively subjective. About half of the women in the study with dense breasts turned out to have low risk of developing cancer. And of those with higher risk, only 24% would have benefited from additional screening such as having an MRI or ultrasound. Overall, that means only 12% of the population of women getting screened by mammograms, including those with dense breast tissue, would need additional screening.

MORE: New Genetic Test for Breast Cancer Would Be Cheaper and Easier

That’s a dramatic difference from the current practice, in which almost all women with dense breasts are advised to consider supplemental screening. In fact, 22 states now mandate that doctors who receive a report that their patient’s breasts contain dense tissue must discuss potential additional screening with their patients. A federal law requiring the same discussion is currently under review. Not all insurers cover this extra screening, however, which raises questions about how cost effective and useful it might be.

The latest results hint that the practice may not be justified. About 42% to 45% of women who get screened will have dense breast tissue, and “you can’t do supplemental screening for 45% of the population,” says Kerlikowske. “It’s just not realistic, neither from a time or cost standpoint.”

MORE: Many Breast Cancer Patients Get Unnecessary Radiation

As the study shows, it’s possible to figure out which women with dense breasts are more likely to develop cancer by considering not just their breast density but other risk factors as well. “I think people right now are looking at the density report from the mammogram and not taking into account age and other factors,” says Kerlikowske. “But you can’t; you have to look at the risk factors together.”

If everyone with dense breasts received additional screening, 1,124 women would have to be screened to catch one potential case of cancer. By incorporating the other risk factors, that number drops to 694.

Now that Kerlikowske and her team have zeroed in on a way to identify the women with dense breasts at highest risk of developing cancer, they plan to look at whether MRI and ultrasound tests can help these women to avoid aggressive disease and live longer.

TIME medicine

Many Americans Aren’t Getting Cancer Screenings, Gov Says

Numbers are below national targets

A new federal report shows a high number of Americans are not undergoing recommended screenings for colorectal, breast and cervical cancers.

New data released Thursday from the U.S. Centers for Disease Control and Prevention (CDC), shows that in 2013, which is the latest data available, screening for the three cancers either dropped lower than previous rates or showed no improvement. The numbers show that around 20% of women said they were not up to date with cervical-cancer screenings, and a quarter of women were not getting recommended breast cancer screening. Overall, two in five adults had not had their recommended colorectal screening. The new report was published in the CDC’s Morbidity and Mortality Weekly Report.

The CDC looked at data from the 2013 National Health Interview Survey and compared the screening rates to the target numbers for “Healthy People 2020,” a national disease prevention initiative that has based cancer screening goals on the U.S. Preventive Services Task Force (USPSTF) guidelines.

Current USPSTF recommendations are mammography every two years among women between the ages of 50–74 years, a Pap test every three three years for women between the ages of 21 to 65 without hysterectomy, and screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults between age 50 to 75.

The number of mammography screenings remained fairly unchanged from previous years, whereas Pap test use among women between the ages of 21 to 65 was lower than it was in 2000. Colorectal cancer screening was unchanged in 2013 compared to what it was in 2010.

The percentages are below the target numbers for Healthy People 2020. The mammography target is 81.1%, and the 2013 data shows the number is currently at 72.6% for the recommended age group. Nearly 81% of women ages 21 to 65 had a Pap test, but the Healthy People 2020 target is 93%. Around 58% of adults between age 50 to 75 reported they had undergone screening for colorectal cancer, and the target for that group is 70.5%.

Though the new report doesn’t explain why the numbers are not meeting national goals, there are some hints. For instance, the data also showed that people without health insurance or a source of health care had the lowest rates of cancer screening test use.

“Though the [USPSTF] does not consider costs or insurance coverage in its evaluation of the evidence, it will be interesting to see whether declines in the number of uninsured in the U.S. since 2013 will be reflected in improved prevention in these populations,” says Dr. Albert L. Siu, the chairperson of the USPSTF. “As clinicians, we also hope that our nation will continue to strive to help all individuals get access to those preventive services that can enable people to live healthier, longer lives.” Siu was not involved in the CDC report.

TIME World

This Young Woman Fighting Stage-4 Cancer Remains Positive and Inspirational

Nicole Jannis, 29, was diagnosed with breast cancer last year

Having a stage-4 cancer diagnosis at 29 might prompt some people to frantically attempt every far-flung journey on their bucket lists.

But Ontario resident Nicole Jannis – who is continuing to fight the disease – says her goals are much simpler.

“You really just want to sit at home with your husband and your dog and watch Netflix and do what’s normal to you. That’s what you crave,” Jannis told Yahoo! News’s Daily Brew in a story that detailed her fighting spirit and upbeat attitude in the face of cancer.

Jannis wasn’t surprised by her breast cancer diagnosis last year, as cancer runs in her family and she had been told she was BRCA positive at 27.

She always assumed it would be an inconvenience she would treat and beat.

“From the very beginning it was, ‘All right! I’m going to go through cancer, and this is going to be something I do and then be done with it and I’ll move on and have my babies and life carries on.’ I never ever wavered from that,” said Jannis.

To keep the mood light, she and her mom wore wacky outfits to her chemotherapy appointments. She also chronicled her cancer journey with a series of optimistic posts on her blog, Boobie and the Beast.

“I think that’s a huge testament of how I’ve been able to get through this past year, probably denial, but also pure optimism to the point where I was like ‘Oh, I’ll never die from this, that’s crazy,’ ” she said.

Staying on top of her treatment and feeling positive about her prognosis, she was taken aback in January when she was told the cancer had been deemed stage 4 and “terminal,” metastasizing to her bones and spreading to her liver and lungs.

Now faced with a new reality, Jannis admits it took some time to adjust.

“I remember throwing up right away ’cause that was just my go-to,” she said of learning the grim diagnosis. “It was just utter despair at first, like holy s—, let’s just give up.”

But after the shock wore off, Jannis’s upbeat spirit shined through again – and she is choosing to continue her treatment.

“You can only wallow for so long,” she said. “You should never be told you’re going to die, because I think if you believe that then you will.”

“I’m positive because I don’t know how not to be,” she added.

This article originally appeared on People.com.

TIME Cancer

Removing Ovaries During Breast Cancer Could Save Lives, New Research Says

For women with the BRCA1 mutation and breast cancer, a new study finds potential benefits from removing ovaries

In women who have both breast cancer and the BRCA1 mutation, having surgery to remove the ovaries can significantly lower their risk of dying from the disease, suggests a new study published in the journal JAMA Oncology.

Women with BRCA1 or BRCA2 genetic mutations have up to a 70% risk of getting breast cancer and a high risk for ovarian cancer. Like actress Angelina Jolie, these women will often consider undergoing preventative surgeries to remove the breasts and ovaries to keep that risk at bay. Now, a new study shows that for women who already have cancer and have a BRCA1 mutation, surgery to remove ovaries—called oophorectomy—could lower the risk of dying of breast cancer by 62%.

Women with BRCA mutations who already have breast cancer will often consider also removing their ovaries to prevent ovarian cancer or secondary breast cancer. Hormones from the ovaries are thought to stimulate the breast tissue and contribute to breast cancer risk.

The study looked at 676 women with stage I or II breast cancer and a BRCA1 or BRCA2 mutation. They were observed for up to 20 years after their diagnosis. Among the women, 345 underwent oophorectomy and 331 women kept their ovaries. At 20 years, the overall survival rate was around 77%—and the women who opted to remove their ovaries had a 56% lower risk for breast cancer death than women who didn’t. For women with the BRCA1 mutation, oophorectomy was associated with a 62% reduction in risk of death from breast cancer, but there was no significant association for women with the BRCA2 mutation. The study authors note that the number of women in the study with the BRCA2 mutation was also much lower than those who had BRCA1.

“The data presented here suggest that oophorectomy should be discussed with the patient shortly after diagnosis,” the study authors write. “We recommend that the operation be performed in the first year of treatment to maximize the benefit.”

Oophorectomy proved particularly beneficial for women with estrogen receptor–negative breast cancer. “It seems kind of counterintuitive,” says Dr. Robert DeBernardo, a gynecology-oncology surgeon at Cleveland Clinic’s Women’s Health Institute (who was not involved in the research). “The ovaries make the estrogen, and if we take it out, we expect to see less estrogen positive breast cancers, but we see a benefit from estrogen negative cancers. That very well may be because the ovary doesn’t just make estrogen or progesterone. It may also make some other things that we have not recognized.”

For women with BRCA mutations, DeBernardo says the study offers more insight into the risk and benefits of their surgical options. “All women with BRCA1 and BRCA2 mutations [will likely] see a specialist like myself to talk about the role of removing their ovaries and tubes,” says DeBernardo. “Now we have something else to discuss to make it easier to make a decision.”

TIME medicine

Hormone Treatments Raise Cancer Risk Even After They’re Stopped

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Estrogen and progestin therapy to treat menopause has led to controversial and confusing recommendations. But in the latest and longest term look at the data, experts say the risks of the hormones may last long after women stop taking them

Researchers admit that when it comes to hormone therapy — estrogen and progestin — to treat the symptoms of menopause for women, they don’t have a lot of consistent or convincing answers. They thought the medications could not only help menopause symptoms but also protect against heart disease, although some studies showed the added hormones could also raise risk of breast cancer. The resulting advice to women seeking answers about whether hormone therapy is for them has been anything but satisfying.

Now the scientists involved in the first large trial of hormone therapy, the Women’s Health Initiative (WHI), have continued to study those women who participated in the 1990s and found some surprising results. Reporting in the journal JAMA Oncology, they say that the risk of breast cancer for women taking the combination of estrogen and progestin remains the same seven to eight years after they stop the drugs than while they were taking them.

MORE: Hormone Replacement Therapy After Menopause: What Women Need to Know

The estrogen helps to maintain levels of that hormone as natural amounts start to drop during menopause, and the progestin protects the uterus from potential tumors arising from excess amounts of estrogen. They also found that for the quarter or so post-menopausal women who have had a hysterectomy, and can take estrogen alone, the hormone can lower their risk of breast cancer.

The WHI was created to study the health effects of hormone therapy on the millions of women taking them. Some small studies had suggested that the hormones could protect women from heart disease; women tend to have heart attacks about a decade or so later than men on average, and researchers believed some of that protection came from estrogen. But doctors were concerned about the known connection between estrogen and breast cancer, since during puberty estrogen contributes to breast tissue growth, and wanted to understand how the benefits for the heart matched up against the risks to the breast, so they enrolled more than 26,600 women aged 50 to 79 years in the WHI.

MORE: Estrogen After Menopause Lowers Breast Cancer Risk for Some Women

They intended to study them until 2005, but in 2002, they stopped the trial when it became clear that there was a group of women experiencing higher heart disease rates. It turned out that these were the women taking hormones, either the combination or estrogen alone.

MORE: The Truth About Hormones

The results completely changed menopause treatment, and led to a precipitous drop in the use of the medications; in the U.S., where about 40% of women turned to the hormones, only 15% did after most experts agreed that they should only be used in the short term, for about a year or so during and just after menopause. The assumption was that the benefits in lowering breast cancer risk would be similar — if women stopped taking the hormones, then their risk would decline.

That seemed to be true, at least for the first year or so after discontinuing the therapy. But in 2013, Dr. Rowan Chlebowski, an oncologist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, and one of the initial investigators on WHI, reported that the benefit didn’t hold for long. He found that if women who had previously been on estrogen and progestin therapy were studied for more than eight years, their risk of breast cancer started climbing back up, to levels that were on par with when they were taking the medications.

That finding, however, contradicted other results from studies. And to make matters more confusing, the women who had had a hysterectomy, and no longer had a uterus so could take estrogen alone, did not seem to experience the same increased risk of breast cancer. All of this data prompted Chlebowski to do a more detailed analysis of the WHI data on women who agreed to continue to participate years after they stopped taking the hormone therapy.

MORE: Making Sense of Hormone Therapy After Menopause

In the current study, it’s clear that the combination of estrogen and progestin increases breast cancer risk, he says. The drop in risk that occurs immediately after the therapy is stopped is likely due to the changing hormone environment. Any small or emerging tumors that were already present before hormone treatment started may eventually start growing again years later.

For women who have had a hysterectomy, taking estrogen alone does not increase breast cancer risk and may, according to the latest results, even provide some protection against the disease.

“It looks like hormones have longer term lingering effects,” says Chlebowski. “For estrogen and progestin together, we see an increase in risk even years after you stop. But for estrogen alone, it looks like the hormone may be more favorable in reducing breast cancer risk than we thought before. The estrogen alone findings are now quite compelling that we may had to call lit risk reduction.”

The results should stress the importance of defining what menopausal symptoms are, and how much they interfere with women’s daily lives. Most health groups now recommend short term hormone therapy, but it’s clear that the risks of breast cancer remain even after exposure. So doctors and patients need to weigh the relief of symptoms against the unhealthy legacy of taking these medications. “There is a little more risk than we thought with estrogen and progestin,” says Chlebowski. “But it’s always difficult to figure out how to categorize that risk. It’s different for each woman.”

TIME Cancer

New Genetic Test for Breast Cancer Would Be Cheaper and Easier

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Color Genomics Saliva test kit offered by Color Genomics

The test would cost just $249

A startup is developing a cheaper, easier way of determining whether women are genetically at risk for breast cancer, in a move that could revolutionize the way women are currently screened for the disease.

Currently, genetic testing for breast cancer risk is expensive and usually reserved for women who have a family history of the disease. But the startup Color Genomics is offering a saliva test that would cost only $249, about one-tenth the cost of many other genetic screens for breast cancer, the New York Times reports.

The saliva test analyzes BRCA1 and BRCA2, the two primary genes where mutations increase breast cancer risk, along with 17 other genes. Elad Gil, chief executive of Color Genomics, said he wants to “democratize access to genetic testing” and that the low cost of the saliva test means women could pay out of pocket if their insurance company did not cover the test.

Still, there are concerns. Some experts worry that the low cost of the test may not include a full analysis, and others raised concerns that greatly expanding the number of women tested could create confusion for those whose test results are unclear.

[The New York Times]

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