Re-Examining Genetic Screening and Oral Contraceptives: A Patient-Centered Review
AbstractThe World Health Organization classifies combined hormonal contraception as an unacceptable health risk in the presence of a known thrombogenic mutation but advises against routine thrombophilia screening before initiating combined oral contraceptives (COCs) on the grounds of high screening costs and low prevalence. From the perspective of patient-centered care, we examine cost, prevalence, and other published arguments for and against thrombophilia screening before initiating COCs. Our patient-centered review draws on relevant empirical evidence concerning the advantages and disadvantages of thrombophilia screening, while placing the discussion in the broader context of evolving attitudes toward genetic testing and a shifting policy landscape that provides many women direct access to COCs and/or thrombophilia screening. Given variation in prior probabilities of thrombophilia, expected exposure to other risk factors for venous thromboembolism, attitudes towards risk, expected reactions to a positive test result, ability to pay, and concerns about genetic discrimination, we conclude that the current one-size-fits-most approach is not consistent with patient-centered care. Instead, we advocate for greater patient and provider education concerning the implications of thrombophilia screening. Moreover, we recommend offering patients optional thrombophilia screening before initiating COCs. View Full-Text
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Hiedemann, B.; Vernon, E.; Bowie, B.H. Re-Examining Genetic Screening and Oral Contraceptives: A Patient-Centered Review. J. Pers. Med. 2019, 9, 4.
Hiedemann B, Vernon E, Bowie BH. Re-Examining Genetic Screening and Oral Contraceptives: A Patient-Centered Review. Journal of Personalized Medicine. 2019; 9(1):4.Chicago/Turabian Style
Hiedemann, Bridget; Vernon, Erin; Bowie, Bonnie H. 2019. "Re-Examining Genetic Screening and Oral Contraceptives: A Patient-Centered Review." J. Pers. Med. 9, no. 1: 4.
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