17 October 2017

BCRA gene tests gain MBS listing

Cancer Clinical

Breast and ovarian cancer patients will soon have access to Medicare-funded genetic testing to help determine whether their cancer is genetic and predict the risk of future cancers.

Specialists would also be able to order subsidised testing for at-risk family members of those known to have the gene mutation, Cancer Council CEO Professor Sanchia Aranda said.

The MBS item numbers, which come into effect on November 1, will eliminate a major barrier to testing by saving patients many hundreds of dollars and extended wait times.

“The reason why it is important is that knowing ahead of time that you have a BRCA mutation allows you to make better screening and treatment decisions,” Professor Aranda said.

For example, if women know they have the genetic mutation, they know they are at risk of developing breast or ovarian cancer at a younger age.

They might opt to have their families earlier and then have surgical removal of their breasts or ovaries as prophylaxis, she said.

“It also allows them to be more alert for symptoms and work with their doctors on a tailored screening and surveillance program to make sure the cancers are diagnosed early and are more likely to be cured.”

BRCA mutation carriers, not just people who already have cancer, will also have access to monitoring and preventative measures such as prophylactic surgery as part of the new funding.

“It is a huge milestone and will significantly improve the lives of Australians, offering more choice via access to affordable screening and treatment options,” Dr Melody Caramins, chair of the Royal  College of Pathologists of Australasia Genetics Advisory Committee, said.

The pathologists’ college was excited to announce the MBS listing, which brings to bear the fruits of a several-year process since they applied to the Medical Services Advisory Committee for item numbers.

“I can think of a lot of superlatives,” Dr Caramins told The Medical Republic.

This is the first multigene test approved on the MBS, and while the final MBS item descriptor has not been published at time of print, it is also thought to include other genes such as PTEN, STK11, and PALB2 known to be associated with a high risk of breast and ovarian cancer.

“These measures are taken so patients can avoid receiving a positive cancer diagnosis in the first place,” Dr Caramins said.

And while these mutations were known to be responsible for a small, but important, proportion of breast and ovarian cancers, it was also important for patients to understand that there were other modifiable risk factors, such as weight and alcohol consumption.

The presence of one of the mutations might help motivate women to modify these, Professor Aranda said.

Some red flags to refer a cancer patient to a specialist for gene testing include a history of breast cancer at age 50 or younger, a history of bilateral breast cancer, a strong family history of breast cancer or Ashkenazi Jewish ancestry.