Cost Of Genetic Testing For Breast Cancer

Genetic Testing After A Breast Cancer Diagnosis

Genetic testing may be recommended for you if youve been diagnosed with early or metastatic breast cancer. Genetic testing looks for gene mutations in the hereditary genes of a person.

If you have breast cancer, genetic testing:

• May help guide your breast cancer treatment
• Gives you the chance to learn if your breast cancer is related to an inherited gene mutation

Fighting To Bring Down Costs

Health insurers aren’t required to cover cancer screenings, beyond what is mandated by the ACA, which is focused on the “average risk” population. That leads many to struggle to get coverage for earlier, more intensive screenings and risk-reducing surgeries, according to FORCE.

While insurance typically covers the surveillance, those who have high-deductible plans may still wind up with a hefty bill, said FORCE’s Schlager.

“We are testing people but not empowering them with easy access, necessarily, to the follow-up care,” she said.

Medicare doesn’t cover preventive care, unless authorized by Congress. Right now, those over 50 years old can get screening colonoscopies covered and those over 40 can get screening mammograms â as well as a baseline between the ages of 35-39. However, anyone younger on Medicare, such as those with disabilities, won’t be covered.

Medicare also doesn’t cover breast MRIs, which doctors recommend for those with a high breast cancer risk, as well as preventive surgeries, Schlager said.

Our whole health system is focused on treatment. If we were to flip that and focus on prevention, we would probably save the system a lot of money long-term.Lisa Schlagervice president of public policy at FORCE

She’s currently working on legislation with Sen. Lisa Murkowski, R-Alaska, and Rep. Debbie Wasserman Schultz, D-Florida, to amend the Medicare statute to broaden the preventive cancer screenings.

What Do The Results Mean

Once your sample is submitted, youll receive your results in 2 to 4 weeks. A healthcare professional or genetic counselor will contact you and discuss your results.

Results you can receive include:

• Positive: A known gene variation that increases your risk of breast cancer was detected.
• Negative: A known gene variation that raises your risk of breast cancer was not detected.
• Variant of unknown significance: A variant has been found in a gene, such as BRCA1 or BRCA2, but its impact on breast cancer risk is currently unknown.

Genetic testing results can be complex. Work with a genetic counselor to help understand what your results mean, so you can plan for next steps.

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How Does Genetic Testing For Breast Cancer Work

Genetic testing for breast cancer risk typically uses a sample of blood, saliva, or cells from the inside of your cheek. After the sample is collected, its sent to a lab specializing in genetic testing to be analyzed.

Several gene variations that increase breast cancer risk have been found. The most important are those in the BRCA1 and BRCA2 genes. According to the National Cancer Institute, about people have a harmful BRCA variation.

About of females with harmful BRCA1 and 45 to 69 percent of females with harmful BRCA2 variations will develop breast cancer by age 80. Their risk of getting breast cancer in the other breast is also higher.

Other gene variants that may raise breast cancer risk include:

Gene variations that can be detected may vary by test. For example, some tests may only cover the most common variations, while others may be more extensive.

Once your sample is submitted, youll receive your results in 2 to 4 weeks. A healthcare professional or genetic counselor will contact you and discuss your results.

Results you can receive include:

• Positive: A known gene variation that increases your risk of breast cancer was detected.
• Negative: A known gene variation that raises your risk of breast cancer was not detected.
• Variant of unknown significance: A variant has been found in a gene, such as BRCA1 or BRCA2, but its impact on breast cancer risk is currently unknown.

Learning About Your Family Background

If you or any of your family members have had breast cancer, you may be a candidate for genetic testing. The best way to get started is to learn more about your family history on your mothers and fathers sides. An abnormal gene that increases breast cancer risk is more likely to run in your family if:

• your family is of Ashkenazi Jewish descent

You may be interested in meeting with a genetic counselor a medical professional specially trained to understand and provide information about genetics and disease. A genetic counselor works with you to build a family tree that shows all cases of breast, ovarian, and other types of cancer in your family, along with the ages at which they occurred. This visual history can help you determine whether or not genetic testing makes sense for you. Before you can build this family tree, however, you may need to do some research.

As you identify possible cases of breast cancer or ovarian cancer in your family, try to confirm them with medical records and a pathology report whenever possible.

For example, if one of your aunts died of liver cancer, its important to find out whether she was diagnosed with breast cancer that spread to the liver or with cancer that actually started in the liver. If your grandmother was diagnosed with stomach cancer, further investigation may show that it was really ovarian cancer that spread inside the abdomen, affecting her stomach.

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Are Test Results Accurate

Genetic testing is generally quite accurate. Although no test is right 100% of the time, the current methods used to detect genetic mutations produce trustworthy results. A false-positive result is very unlikely. A false positive result indicates an abnormality when none is actually present.

However, it is more likely that you could have a negative test result when you actually have a harmful gene mutation. This is because genetic tests will miss gene mutations they do not test for. Some genetic tests, such as direct-to-consumer tests, only look for particular gene mutations. They can miss other BRCA mutations or harmful mutations in other genes that may increase cancer risk.

In addition, our understanding of gene mutations and cancer risk is growing rapidly. Research is ongoing to discover new gene mutations that increase a persons risk of cancer.

Talking With Your Health Care Provider

If you have questions about inherited gene mutations related to breast cancer or genetic testing for treatment decisions, talk with your health care provider.

Your health care provider can help you understand how genetic testing may help you and can refer you to a genetic counselor if needed.

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Telling Your Loved Ones

Receiving a positive test result will most likely have an emotional impact, not just on you, but on other members of your family . They may be concerned about your health, but also their own, if they are blood relatives.

You may want to urge your family members to get tested and invest in breast cancer prevention strategies, but remind yourself that each person will process this information differently and make the decision that is right for them.

What A Positive Result Means

If your predictive genetic test result is positive, it means you have a faulty gene that raises your risk of developing cancer.

It does not mean you are guaranteed to get cancer your genes only partly influence your future health risks. Other factors, such as your medical history, lifestyle and your environment, also play a role.

If you have one of the faulty BRCA genes, there is a 50% chance you will pass this on to any children you have and a 50% chance that each of your siblings also has it.

You may want to discuss your results with other members of your family, who may also be affected. Staff at the genetics clinic will discuss with you how a positive or negative result will affect your life and your relationships with your family.

You can read more about BRCA1 and BRCA2 in the beginner’s guide to BRCA1 and BRCA2 produced by The Royal Marsden NHS Foundation Trust.

Insurance companies cannot ask you to disclose the results of predictive genetic tests for the majority of policies, but this may change in the future.

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What Does Brca Gene Mutation Testing Measure

There are many different mutations in the BRCA1 and BRCA2 genes that may be detected during BRCA gene mutation testing. Which genes are tested depends on your circumstances:

• Most patients will have what is known as a multigene panel test. Multigene panel tests can detect a broad array of BRCA1 and BRCA2 mutations, as well as harmful mutations in other genes that can increase cancer risk.
• If a particular mutation has been found in a family member, you may be tested only for that known gene mutation.
• In Ashkenazi Jews, three particular BRCA mutations are much more common than in other ethnic groups. These mutations are known as founder mutations. If testing is performed because of concerns about ancestry, testing may be limited to these three mutations.

Does Insurance Cover Brca Testing

In the United States, BRCA testing is usually covered by insurance if the patient meets certain criteria. Insurance coverage and criteria varies by insurance plan, and genetic counselors will review potential costs and insurance coverage with you during your appointment.

Some insurance companies have specific testing criteria or do not cover testing in certain situations, even when it is considered medically appropriate. For example, Medicare has specific BRCA testing criteria that only includes individuals with a personal history of cancer. Therefore, Medicare does not cover someone with a known mutation in the family who has no personal history of cancer. Medicaid coverage typically varies by state.

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Prophylactic Mastectomy For Diabetic Mastopathy

Agochukwu and Wong stated that diabetic mastopathy is a benign condition of the breast that typically manifests in patients with diabetes mellitus. Lymphocytic mastopathy is the term used to describe this condition in patients without diabetes mellitus. Most patients undergo excisional biopsy, but the use of mastectomy, even in cases of diffuse, bilateral disease, is rarely reported. These investigators presented the case of a 32-year old woman with type 1 diabetes and bilateral diabetic mastopathy. Because of pain, and concern for limitations in future cancer detection, she underwent bilateral NSM with immediate direct-to-implant reconstruction. A systematic literature review was performed to examine the therapeutic options for this disease, particularly from a plastic surgery perspective. A total of 60 articles were reviewed that contained information regarding 313 patients. Of these patients, only 4 underwent mastectomy. The authors concluded that this case was the 1st report of bilateral NSM and immediate implant reconstruction for a patient with bilateral, symptomatic diabetic mastopathy.

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What Do Brca1 And Brca2 Genetic Test Results Mean

BRCA1 and BRCA2 mutation testing can give several possible results: a positive result, a negative result, or a variant of uncertain significance result.

Positive result. A positive test result indicates that a person has inherited a known harmful variant in BRCA1 or BRCA2 and has an increased risk of developing certain cancers. However, a positive test result cannot tell whether or when the tested individual will develop cancer. Some people who inherit a harmful BRCA1 or BRCA2 variant never develop cancer.

A positive test result may also have important implications for family members, including future generations.

• Both men and women who inherit a harmful BRCA1 or BRCA2 variant, whether or not they develop cancer themselves, may pass the variant to their children. Each child has a 50% chance of inheriting a parents variant.
• All blood relatives of a person who has inherited a harmful BRCA1 or BRCA2 variant are at some increased risk of having the variant themselves. For example, each of that persons full siblings has a 50% chance of having inherited the variant as well.
• Very rarely, an individual may test positive for a harmful variant not inherited from either parent. This is called a de novo variant. Such a variant is one that arose in a germ cell of one of the parents and is present in all the cells of the person who grew from that cell. The children of someone with a de novo variant are at risk of inheriting the variant.

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What Are The Next Steps After Brca Gene Testing

Once youve taken a BRCA gene test, there are three possible test results you can receive:

• Positive. A positive result indicates the presence of a harmful BRCA1 or BRCA2 variant, which places you at an increased risk of developing breast, ovarian, or other cancers.
• Negative. A negative result indicates one of two things: 1) that you did not inherit a harmful BRCA1 or BRCA2 variant from a close family member, or 2) that you do not have the specific variant tested for but may possibly have another variant.
• Variant of uncertain significance . A VUS result indicates the presence of another genetic variant that is rare but not currently associated with an increased risk of cancer.

Depending on your test results, your doctor or genetic counselor will advise you on the next steps. If you have tested positive for BRCA1 or BRCA2 variants, there are many ways that you can reduce your cancer risk, including annual screenings, certain medications, and preventative surgeries.

How Is Genetic Testing Done

Genetic tests are usually requested by a persons genetic counselor, doctor, or other health care provider who has reviewed the individuals person and family history. The genetic test options from which a health professional may select include those that look at a single gene and those that look for harmful variants in multiple genes at the same time. Tests of the latter type are called multigene tests.

Testing is done on a small sample of bodily fluid or tissueusually blood, but sometimes saliva, cells from inside the cheek, or skin cells. The sample is then sent to a laboratory that specializes in genetic testing. The laboratory returns the test results to the doctor or genetic counselor who requested the test. It usually takes several weeks or longer to get the test results.

Health insurance typically covers genetic counseling and many genetic tests, if they are considered medically necessary. A person considering genetic testing should discuss costs and health insurance coverage with their doctor and insurance company before being tested.

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Breast Cancer Genetic Testing Cost

By Dr. Brandon Colby MD, a physician-expert in the fields of genetic testing and personalized preventive medicine.

Many people turn away from breast cancer genetic testing because of the cost. Despite the value of knowing whether someone has the BRCA1 or BRCA2, people feel the investment in the information is not worth the cost. They take a chance and decide to rely on early detection through breast self-exams and mammograms.

The only issue with this is those with a family history of the BRCA1 and BRCA2 gene mutations are missing out on the opportunity to decrease their cancer risk. By knowing whether someone has the BRCA1 or BRCA2 mutation, people can work with a genetic counselor and health care provider to reduce their chances of developing breast cancer.

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Brca1 And Brca2 Gene Mutations

When it comes to breast cancer risk, the most important inherited gene changes are in the BRCA1 and BRCA2 genes. Women with one of these gene changes are said to have Hereditary Breast and Ovarian Cancer syndrome.

• Women with a BRCA gene change have a greatly increased risk of breast cancer, as well as an increased risk of ovarian cancer, pancreatic cancer, and possibly some other cancers.
• Men with a BRCA gene change are at increased risk of breast cancer , prostate cancer, pancreatic cancer, and possibly some other cancers.

If you have a family history of breast cancer, you have a higher risk of getting breast cancer yourself. Most women with a family history of breast cancer do not have an inherited gene change that greatly affects their risk. Still, an inherited gene change is more likely in women with a strong family history of breast cancer, especially if the family history also includes certain other cancers, such as ovarian, pancreatic, or prostate cancer. The risk of having an inherited syndrome is also affected by:

• Which family members are affected
• The number of family members affected
• The age when your relatives were diagnosed

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How Do You Receive Genetic Screening And Testing

If you are interested in genetic testing for hereditary breast and ovarian cancer, please provide your family cancer history by:

Dr. Madani or a member of her team will review your answers. If the screening results show that you could be at risk for hereditary breast and ovarian cancer, she may refer you for genetic counseling and genetic testing .

Cost Of Genetic Testing To Learn About Inherited Gene Mutations Related To Breast Cancer Risk

If you are getting genetic testing to learn whether your breast cancer is related to an inherited gene mutation that increases breast cancer risk, check with your health insurance company to find out whether the costs of genetic counseling and genetic testing are covered in your plan.

Most insurance plans cover the cost of BRCA1, BRCA2 and other genetic testing if you meet the criteria for testing. Coverage of expanded panel testing varies from plan to plan.

The Affordable Care Act requires insurance plans that began on or after August 1, 2012 to cover genetic testing costs .

Genetic counseling is usually covered if you meet the criteria for testing or have a personal or family history of cancer.

Your health care provider or a genetic counselor can help you determine if your insurance will cover BRCA1/2 or panel testing.

Learn about steps to take if your insurance company denies your claim for genetic testing.

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