KeepHealthCare.ORG – Breast cancer: Calls for genetic test to be funded in NZ
Funding genetic tests for patients with early stage breast cancer would provide them with more certainty and clarity about their treatment options, a New Zealand oncologist says.
It follows the release of an American study which found about 70 percent of women in the early stages of breast cancer might be able to skip chemotherapy.
Auckland woman Louise Kuegler was diagnosed with an early stage, slow growing breast cancer in April last year.
Based on this, her oncologist recommended a treatment plan that included hormone therapy and radiotherapy, but not chemotherapy.
He also mentioned a ‘mammaprint’, which involved sending samples of her tissue to the United States for testing.
Louise and her husband decided to pay $6000 themselves for the test, which isn’t covered by private medical insurance or the public health system.
“The test came back with a surprisingly different result than what was expected, which was that it was actually a high-risk breast cancer, so based on that information my oncologist then changed my treatment plan and included chemotherapy alongside the other treatment as well,” she said.
The test is used for women who have early stage breast cancer, once they have had surgery, to determine the risk of the cancer returning.
These women are already on long-term hormone medication, but the study, published in the New England Journal of Medicine, looked at whether adding chemo was effective.
Currently women who get a low score on the test are told they don’t need chemo, while those with a high score are told they definitely do.
But most women get an intermediate result, and their treatment plan is less clear.
Test would provide ‘extra clarity’
Auckland oncologist Reuben Broom is a medical advisor for the Breast Cancer Foundation and is currently in Chicago at the conference where the study’s findings were released.
The study had focussed on a grey area of oncology, he said.
“There are about 15 percent of patients who have lympo-negative hormone receptive positive breast cancer in New Zealand. I think that this test would provide a lot of extra clarity and be able to reassure those patients that omitting chemotherapy is the right decision,” he said.
Dr Broom said because the test wasn’t publicly funded in New Zealand, oncologists relied on the data pathologists gave them to try and determine how aggressive the cancer was.
As a result, most patients were given a treatment plan that was based on a good amount of information that enabled doctors to make a sensible decision.
“But there will be a smaller, but significant number of patients for whom having the extra information with a multi-gene score, such as Oncotype DX, or one of the other platforms, will provide certainty that they are not missing out from any benefit from chemotherapy,” Dr Broom said.
The Breast Cancer Foundation’s research and communication manager Adele Gautier said making the test more widely available meant patients could avoid unnecessary chemotherapy.
“Chemo has huge side effects. The obvious ones are losing your hair, infertility, dreadful pain in the hands and feet, the vomiting and so on, but also long-term effects that are really only being studied now in terms of cognitive function, ongoing pain and, for a small group of patients, heart disease, things like that,” she said.
Ms Kuegler would like the test to be publicly funded.
“If we hadn’t made that choice then I wouldn’t have gone down the path of having chemotherapy and my outcome could potentially have been quite different, so I think it would be fantastic for more women to have the choice to have the right information based on the tests that are available out there,” she said.
The Ministry of Health said the results looked interesting and it would consider the study’s findings.