CHAPEL HILL, N.C. -- Healthcare reform is one of the biggest issues in politics-and one of the most complicated. At a time when advances in healthcare are allowing doctors to individualize and successfully treat diseases, there are still many people who never receive treatment. 

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Dr. Jim Evans is director of the Cancer Genetics Program at the University of North Carolina. In addition to his regular patients, he also oversees lab operations that will bring more targeted and effective treatments for cancer. But Evans says the ability to predict disease brings added challenges.

 

“If for example, I find out that I am at risk for cancer, what am I going to need?” said Evans. “I’m going to need increased surveillance, which costs a lot of money. How are we going to pay for all these new maladies that we are going to be at risk for?”

 

Evans says the burden of paying for testing and treatment will tax an already strained healthcare system.   Statistics from the American Cancer Society back him up. A report released in December claims that uninsured cancer patients are twice as likely to die within 5 years of diagnosis compared to insured patients simply because they lack access to proper screening and treatment. 

 

Dr. Otis Brawley, the chief medical officer for the American Cancer Society, says in virtually every cancer, people with insurance do better than those who do not have insurance.    

 

“Sometimes the lack of quality of care is going to be due to the fact that uninsured patients can’t afford a drug that’s necessary,” said Brawley. “That’s especially alarming when we’re talking about a drug that might alleviate pain or a drug that might alleviate nausea.”

 

Ideally, research going on at UNC and other facilities across the country should make healthcare delivery more efficient.   In fact, Evans says, the cost of DNA testing is actually decreasing. 

 

But many people will be excluded from the advances that genetic medicine offers, including increased education about prevention. As scientific as genetics is, says Evans, it isn’t destiny.   

 

“Genetics is important,” said Evans. “There’s no question that we are, to a significant extent, products of our genes, but we’re also hugely products of our environment, and products of chance. While we can’t alter our genes, we can intervene in those areas that are still very important that we can do something about.”

 

Smoking is a good example. If you know that you are at risk for cancer, he says, becomes even more imperative not to smoke cigarettes.

 

Evans says the benefits of genetic medicine are many, including the opportunity to treat individuals, rather than just treating their disease. The question, he says, is whether the healthcare system will be able to pay for it.