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Medicare Expands Coverage for Breast Cancer Test

Medicare Expands Coverage for Breast Cancer Test
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Published on May 19, 2021

Breast Cancer Index Test Predicts Endocrine Therapy Benefit

Navigating cancer care can be overwhelming, especially when it comes to understanding the costs of tests. But there is good news on the horizon for Medicare recipients. A test that can help women with certain types of breast cancer predict if extended endocrine (hormone) therapies will be effective is now covered under Medicare.

This update is effective immediately, according to Biotheranostics, which developed the test, called the Breast Cancer Index.

“Post-menopausal women who qualify for Medicare coverage can now benefit from knowing confidently whether extended endocrine therapy is worth the risk of long-term side effects associated with treatment, at absolutely no financial cost,” said Kevin Thornal, division president of Diagnostic Solutions at Hologic, which owns the subsidiary Biotheranostics.

“This could also potentially save patients from associated long-term healthcare management costs, as well as preserve quality of life, which for many patients and their families, is an immeasurable gift,” he told Patient Power.

The Breast Cancer Index

The Breast Cancer Index test has been formally studied in several clinical trials and is recognized by the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) for predicting extended endocrine therapy benefit in patients with early-stage, hormone receptor (HR)-positive breast cancer.

Post-menopausal women diagnosed with early-stage, node-positive (one to three lymph nodes), non-relapsed, estrogen receptor (ER) and/or progesterone receptor (PR) positive HER2 negative breast cancer are now covered under Medicare. Previously, Medicare only covered the test for women with node-negative, non-relapsed, ER and/or PR-positive HER2 negative breast cancer.

A Game Changer for Patients

This test can help physicians know when extended endocrine therapy will be beneficial to patients, which is important because of the side effects that patients commonly experience including osteoporosis, bone fractures, and joint pain, according to Biotheranostics. These conditions can negatively affect a patient’s quality of life. This test can help personalize endocrine therapy for all patients with HR-positive breast cancer and help patients avoid what’s called overtreatment, which is when a patient undergoes more treatment than is helpful or beneficial. 

“Patients who meet this criteria and are interested in personalizing their long-term treatment should talk to their doctors about getting tested with Breast Cancer Index,” Thornal said.

Learn More about the Breast Cancer Index at ASCO 2021

More information about the Breast Cancer Index will be presented during the upcoming annual meeting of the American Society of Clinical Oncology (ASCO), looking specifically at the efficacy of the test in clinical trials. This meeting is free to patient advocate members of ASCO. For more information, visit conferences.asco.org/am/registration.

~Lauren Evoy Davis

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See Our Sources

  • Validation of the Breast Cancer Index Test: Clinical Cancer Research. (2021). “Breast Cancer Index Predicts Extended Endocrine Benefit to Individualize Selection of Patients with HR+ Early-stage Breast Cancer for 10 Years of Endocrine Therapy.” https://clincancerres.aacrjournals.org/content/27/1/311
  • Trial Data on the Breast Cancer Index Test: Journal of Clinical Oncology. (2020). “Breast cancer index (BCI) predicts benefit of two-and-a-half versus five years of extended endocrine therapy in HR+ breast cancer patients treated in the IDEAL trial.” https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.512

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