The Logistics of Multigene Panel Testing in Breast Cancer

BECAUSE OF UNCERTAINTIES ASSOCIATED with multigene panels, not everyone should get the tests.

Recommended for testing are people with or without breast cancer whose personal or family history of the disease suggests a genetic susceptibility. Guidelines followed by most physicians and also used by insurance companies for reimbursement come from the National Comprehensive Cancer Network..

For instance, people who have a family member with any of the following should be tested: a BRCA1 or BRCA2 mutation, breast cancer at 50 or younger, breast cancer in both breasts, triple-negative breast cancer under age 60 or ovarian cancer. Also, individuals who had breast cancer at age 50 or younger, or who are of Ashkenazi Jewish descent with breast cancer in the family, should be tested. Finally, all women diagnosed with ovarian cancer, and males with breast cancer, should be tested..

Generally, health insurance covers the cost of genetic testing recommended by a physician. However, some patients who had BRCA testing in the past have had trouble getting reimbursed for a follow-up panel test. The outof- pocket cost for a single panel test can be up to $5,000, although lower-cost tests are available.

“If you have only one bullet in your gun and can only get the test reimbursed by health insurance once, are you going to evaluate just two genes, or all genes associated with the risk of breast cancer?” asks Gregory Idos, M.D., assistant professor of clinical medicine at the University of Southern California. “In the field, you’re starting to see a lot of practitioners move toward panels so they can get as much important information for their patients, that will be appropriately covered by insurance, (as possible).”

Some companies are willing to work directly with patients using their own physicians, but Couch says that genetic testing should be ordered by a doctor who knows the patient’s history. The Food and Drug Administration, Federal Trade Commission and Centers for Disease Control and Prevention all caution against using at-home testing kits for breast cancer risk.