The Precision Medicine Initiative, which tailors treatment and prevention to an individual’s unique characteristics, represents a significant shift from traditional public health approaches. However, precision medicine both aligns with and conflicts with public health goals.

Precision medicine offers powerful tools that align with the public health mission of disease prevention and health equity. By using genetic screening, public health can identify subgroups at high risk for diseases like hereditary breast and ovarian cancer (HBOC) due to BRCA1/2 mutations. This allows for targeted, efficient prevention strategies, such as increased surveillance or risk-reducing surgeries, which is a more sophisticated form of risk stratification that public health has always practiced. Large-scale research programs, such as All of Us, seek to address health disparities by building diverse genomic databases. The knowledge gained helps ensure new diagnostics and treatments are effective for everyone, directly supporting the goal of achieving health equity. On the other hand, the individualized focus of precision medicine creates tension with public health’s population-level orientation. Public health often relies on low-cost, high-impact interventions, such as vaccination and sanitation.

This cost issue can exacerbate health inequities. Access to genetic screening is often limited by socioeconomic status. As studies on BRCA testing show, Black women are less likely than White women to be referred for genetic counseling, even when they meet the same clinical criteria (Cragun et al., 2017). Unless equitable access is guaranteed, precision medicine risks creating a two-tiered system of healthcare, which is directly opposed to the public health goal of ensuring health for all. Finally, a focus on genetic risk can divert attention from the social and environmental determinants of health, such as poverty and pollution. This creates a conflict in priorities, pitting a molecular view of health against a socio-ecological one.

For a condition like HBOC, public understanding is vital for informed decision-making. Two ideal online resources provide information and support for HBOC. The CDC website and the website for Facing Our Risk of Cancer Empowered (FORCE) are both great resources for those with questions regarding HBOC.

The CDC’s webpage on BRCA gene mutations is an authoritative, evidence-based resource (CDC, 2024). Its primary strength is its credibility. The content is structured logically, explaining what HBOC is, who is at risk, and the guidelines for testing. However, its main weakness is its clinical and impersonal tone. While factual, it lacks the personal stories and emotional context that can help people process the challenging experience of discovering a high genetic cancer risk.

FORCE is a nonprofit organization with a patient-centered website (FORCE, 2024). Its greatest strength is its focus on the lived experience of having a BRCA mutation. It excels at providing personal stories, support networks, and practical advice on navigating risk-management options. It creates a sense of community that can be invaluable. Its weakness is that, as an advocacy organization, its content is naturally framed to empower patients and may not present epidemiological data with the same neutral tone as the CDC.

References

Centers for Disease Control and Prevention. (2024, May 30). People at Increased Risk for BRCA Gene Mutations. https://www.cdc.gov/breast-ovarian-cancer-hereditary/risk-factors/

Cragun, D., Weidner, A., Lewis, C., Bonner, D., Kim, J., Vadaparampil, S. T., & Pal, T. (2017). Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors. Cancer, 123(13), 2497–2505. https://doi.org/10.1002/cncr.30621

Facing Our Risk of Cancer Empowered. (2024). Overview of Hereditary Cancer Treatment. https://www.facingourrisk.org/info/risk-management-and-treatment/cancer-treatment/overview