No public funding for early breast cancer test: What should GPs know?

Women who may have used the MammaPrint genomic test for early breast cancer, and who have concerns over how it may have impacted on their care, should be encouraged by GPs to discuss it with their treating specialist, an expert has told newsGP.
 
Last year, the Australian company Genome Investigation applied to have the MammaPrint test – which is available in Australia privately for around $5400 – funded on the Medical Benefits Schedule.
 
The 70 gene signature test is used alongside a clinical risk assessment, to quantify the risk of tumour recurrence after local treatment for early breast cancer and predict whether adjuvant chemotherapy would be beneficial. The test classifies patients as low genomic risk or high genomic risk. The MammaPrint test was proposed to inform decisions about the use of chemotherapy in women with high clinical risk breast cancer and ‘low genomic risk’.
 
The Government’s Medical Services Advisory Committee (MSAC) did not support the application after analysing the data from the key supporting clinical trial, MINDACT, finding overall that breast cancer outcomes were poorer in women who did not have chemotherapy based on the MammaPrint test compared with those who received chemotherapy.
 
‘As a result, MSAC had little confidence that the MammaPrint test could be used to justify withholding chemotherapy without negatively impacting upon important outcomes, including overall survival,’ the findings state.
 
Dr Liz Marles, who represented the RACGP in Cancer Australia meetings on the issue, told newsGP that the key message for GPs is to encourage patients to discuss any concerns they have with the use of the MammaPrint test with their specialist treating clinicians.
 
‘It’s important not to alarm people. We all make decisions based on the best information available at that point in time. We don’t know how many women took this test, as it’s private,’ she said. For those women who have had the test, not all women would have changed their treatment decision based on the MammaPrint result.
 
‘We’re not talking about a massive difference in outcomes. Early breast cancer generally has excellent outcomes. So people shouldn’t be alarmed.’
 
Several other countries have also not recommended the test for public funding, including the UK and the Netherlands, where the test was developed.
 
Cancer Australia has now posted information about the MSAC conclusion on MammaPrint on its site.

breast cancer genomic medicine MBS Medicare