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


Doug Hendrie


18/04/2019 3:54:34 PM

An expert has cautioned GPs and patients to not be alarmed over the decision.

Breast cancer X-ray
Dr Liz Marles said 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.

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


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Ex Patient   19/04/2019 8:56:35 PM

My breast surgeon, without consulting the medical oncologist, prescribed letrozole two weeks before my surgery '...as a trial to see how well you tolerate it...'. After the pathology came in the MO said my tumour could never be genomically tested because '...it is tainted by letrozole...' and my Ki67 measure is meaningless due to the letrozole taint. Thanks, Doc!

This is one of several examples of the left hand not knowing what the right hand is doing across my treatment 'team' (who evidently rarely consult one another) in a cancer factory. I've yet to observe the hyperbolic 'patient-centred care', instead seeing continual reinforcement that a patient is nothing more than a dataset.


Ingreyzone   23/04/2019 5:13:50 PM

Whilst I realise that this post relates to Mammaprint, it raises a number of issues related to these types of test. I paid for the Oncotype Dx in 2012. It was suggested by my onc who had been in a previous trial, knowing how bound I was in deciding chemo or not. The test came back showing that chemo had no great benefit for my type. I understood the limitations. Since then there have been results from SOFT and TAILOR X, so I probably made partially the right call. It annoys me there is no ability to be on a voluntary public register that could look at outcomes and treatment regimes patients took. I am missed in the data set. For a 40 yrs old @dx, I'm more concerned with 40 + yr outcomes not 5 yrs.


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