Research Brief: Genetic Testing for Hereditary Cancers Craig Morse BIO 101 SNHU.

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Research Brief: Genetic Testing for Hereditary Cancers Craig Morse BIO 101 SNHU

Expanding the Affordable Care Act’s Requirements to Cover Genetic Testing for Those Already Diagnosed with Cancer.

Summary

History: 2005 – USPSTF provided grade “B” recommendation for BRCA testing to select group of women. ACA mandates recommendations grade “A” or “B” by USPSTF must be covered without cost-sharing CONCERN: This recommendation does not include women who have already been diagnosed with breast and/or ovarian cancer.

What is BRCA? BRCA1 and BRCA2 Up to 87% lifetime risk for breast cancer A 40-60% risk for a second primary breast cancer Up to a 45% lifetime risk for ovarian cancer Identify individual = changes to medical management Incidence of mutation carriers = 1:400

Issues

Issue The ACA’s benefit for BRCA testing does not include women who have been diagnosed with breast and / or ovarian cancer. ASCO NCCN ACMG 2013 USPSTF – “out of their scope”

Recommendations

Recommendation The U.S. government should expand the Affordable Care Act to include coverage for BRCA genetic testing in women who have already had a diagnosis of breast or ovarian cancer. Like the coverage for those meeting USPSTF guidelines, this coverage should exclude cost-sharing.

Reasoning

Arguments For Preventing a new diagnosis is more cost-effective than treating it Reduce mortality Arguments Against Genetic Testing is Costly $ genetic test Prophylactic surgery Reduced imaging/follow-up Cancer diagnosis Surgery Chemotherapy Radiation Years of follow-up

Implications

Conclusions Expansion of the Affordable Care Act’s Requirements to Cover Genetic Testing to Include Those Already Diagnosed with Cancer will result in: Potential for reduction of healthcare dollars Potential for reduction in cancer incidence Potential for reduction in mortality

References Affordable Care Act Implementation FAQs – Set 12. Centers for Medicare & Medicaid Services. Available from: Sheets-and-FAQs/aca_implementation_faqs12.htmlhttp:// Sheets-and- Kroger, J. and A. Park (2013). The Angelina Effect. Time. May 27. Accessed from: Moyer, V.A. (2014). Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014;160: Petrucelli N, Daly MB, Feldman GL. BRCA1 and BRCA2 Hereditary Breast and Ovarian Cancer Sep 4 [Updated 2013 Sep 26]. In: Pagon RA, Adam MP, Ardinger HH, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; Available from: U.S. Preventive Services Task Force. Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. (2005). Ann Intern Med 143: