Just Because We Can, Doesn't Mean We Should, And Who Pays For It

Back when I was first diagnosed with breast cancer, I first learned about the OncotypeDx genomic test for women with breast cancer. Of course I was not eligible for it. I can't remember why - whether it was because it wasn't my first cancer, or I had a single tiny positive node.

I am never eligible for anything because my health is too complicated to be eligible for anything. I have way too many ailments, previous or current treatments, or something. But I digress.

I watched all these other women get the tests to find out their risk of recurrence. Over the years, genomic testing has expanded from the OncotypeDx test to include a group of available tests. Which I was never eligible for....

These tests can provide helpful information. However, would everyone diagnosed with breast cancer benefit from these tests? Would the benefit of these tests outweigh the costs of them? Insurance companies never want to pay for more testing, even when it might show that a patient can have less treatment in the long run. And we cannot forget the additional stress on the patient for more testing.

A group of oncologists met at the Chemotherapy Foundation Symposium and had a moderated discussion about which breast cancer patients should have genomic test. The result of this discussion was:

"...that not every patient needs to undergo genomic testing.

He gave an example of how, traditionally, older women unfit for chemotherapy do not undergo genetic tests. “I think that this can really apply to any age, 3 cm or below, node-negative disease,” he said. Additionally, low-risk patients — possibly 20% to 30% of patients — most likely do not need to be tested, according to Brufsky.

“You really have to choose,” he said. “I think the payer’s like that, the patient’s like that, and I think we’re a little hesitant sometimes to say to [our patients], ‘Listen, you have a tumor that’s just going to do great, no matter what we do, and you don’t need to be genomically tested.’”"
Just because we can offer these tests, doesn't mean we should test every patient. Even without pushback from insurance companies on costs, more testing is never always beneficial for patients. Or for their emotions and wallets.

So what do those test results mean?

A new study shows (because we always need more studies) that women with breast cancer want the genomic tests but then do not understand the results.I am not surprised by this at all. This applies the results of the Oncotype DX, Mammaprint, and Mammostrat tests.

When I was first diagnosed with breast cancer the Oncotype DX test had just been made widely available. Many women who were also hanging out on the online websites for breast cancer support were getting their Oncotype DX test results (of course I was not eligible for the test) and questioning their results.

• Some women would say this is my result and this is what the doctor recommends, do you think I need a second opinion or something to that effect.
• Another group would say these are my results and they are in the middle, what should I do?
• Finally, there would be more women saying, these are my results, did anyone else have these results and what did they do?

It was clear there was a lot of lack of understanding of the test and what it meant. I think the first point is that doctors clearly need to better explain the tests and what their results mean. But we can't blame the doctors for all of this. Women, or any patient who is faced with a new diagnostic or predictive tool like this, need to understand that it is just one more tool in helping to come up with the best treatment plan for them.

Genomic tests are going to be part of the diagnostic and predictive tools available in the future. Education needs to be done for the general public to understand their potential impact and what they mean. To me they represent the next step in understanding the many subsets of different diseases.

Breast cancer is not one disease but hundreds. Every little test like this can help set up the correct treatment plan for each patient and prevent over and under treatment. Greater education needs to be given so that patients better understand that each patient is different and treatment plans are not going to be the same, even if you are treated at the same hospital by the same doctor.