Oncotype DX Test approved by Cdn Insurance Co.s?

Sukisez

Hi, I'm a newbie from Vancouver, wondering if anyone has requested the Oncotype DX Test and whether or not it was approved by your insurance co.

Thanks!

Anonymous

Sukisez,
Yes, there are tons of us that have had the test...my insurance approved it without question....but Im not sure where you are located....I know here in the states our medicare system evens pays for it so the chances are that your insurance will...but if not the company that does the test is wonderful with fighting and getting them to pay...
Jule

Anonymous

DUH, guess I was having moment!!!!!
I see that your in Canada, sorry ....
But I do believe that there are some posters here that are in Canada that have had the test.

bonnie_vanisland

I looked into getting this test last year when I was diagnosed and was told that MSP would not cover it and that I would have to pay (about $3,000)
Hopefully in a few years the test will be standard and MSP will pay.

hi5-2006Aug13

Hi Newbie:
We're nearly neighbours...I live in Fort Langley. No there is no oncotype here. So tell me about you. You can pm me if you want.

jonimb

If you are Canadian, you can get this test thru Medicare. It is still done in the USA, and it does take a while to get your information back about 3 to 6 months. Check with your doctor, as you have to see a genetics counselor.

Sukisez

Do you mean Medicare in the US? I have checked and been told that Medical Services Plan (MSP) of BC does NOT cover the cost of having the test done in California. Maybe it's different in Alberta? I am looking at appealing for both MSP and Pacific Blue Cross (my private insurance co.) Has anyone in BC been successful in getting the cost of this test covered by either MSP or private plan???

Thanks! Suki

jonimb

Suki:

There is a girl...her ID is Aladora, and she had the BRCA testing done in Victoria. Also Zarowney9, I believe she had it too.

This should be covered.

Sukisez

Thanks - very grateful - I sent PM's to both of them...

Suki

Anonymous

Note - BRCA testing and Oncotype DX are two totally different things. Oncotype DX is for early stage, node negative, estrogen positive breast cancers. The intent is to help you decide if chemo will benefit you - e.g. not undertreat or overtreat. The outcome of the test is a score - and with that score you have an idea of the distant recurrance rate. Low scores do not need chemo (chemo would be overtreatment), high scores benefit from chemo (you'd be under treated if you didn't have chemo with a high score). Intermediate - unclear on whether chemo benefits or to what extent. There's a study underway to look at those in the intermediate group - to study the grey area and hopefully come up with clear treatment guidelines for those that fall into the "grey" area. The trial is called the TailorX trial. I'm not from Canada - but saw this thread and thought I'd provide some more info in case it was useful to you.

Doreen

Sukisez

Yes - thanks Doreen - I fit the profile - early stage, node negative, estrogen positive breast cancer for whom this test is most beneficial in determining whether or not chemo will be the best course of action. I contacted the company (Genomics)that has the patent for the test and as a Canadian would have to pay up front and hope that either the provincial or my private health insurance will assist in covering the cost. I am meeting with my oncologist next week and want to make an informed choice; to date I have received conflicting information as to whether or not it can be covered...

Thanks!
Suki

Anonymous

Suki: I hope you can get the test - that it will be covered ... and that you have a low score!!! You might want to ask your oncologist if there's a chance of getting enrolled in the trial ... my cancer center was not participating in the trial - and by the time I found out about the trail - I was too far out from surgery to be eligible - but ... my cancer center enrolled and now has patients participating in the trial. I don't know if the trial is only for the US - it might be since its' being funded by the federal govt - it can't hurt to ask ...
Doreen

Aladora

Suki, I just saw this thread and please ignore my pm...I have not had this test done, just the BRCA one. Sorry that I could not be more help! Good luck getting it covered.

hi5-2006Aug13

My chemo onc sent my path report back for a second look...I was so close to requiring chemo...on the border...I asked about oncotype and he told me they don't have it here... this was at cancer clinic at Surrey Memorial Hospital in June

Sukisez

Thanks Doreen - I believe the TailorX clinical trial is now closed and only available in the US as it is federally-sponsored...what cancer centre were you attached to?

Thanks!

Suki

Sukisez

Well feb, it seems that something ought to be done about this - incredible to me that provincial health would not cover the test when in the long term it would save the public coffers a lot of money (ie: by indicating chemo not required it would save how many $'s, or if chemo required, how many $'s in the patient's future medical management?). As usual, penny wise and pound foolish...MSP's policy in terms of genetic tests is: "Predictive genetic testing is not an insured service for beneficiaries of MSP in BC, and is therefore not funded when performed outside of Canada"...BUT it also states: "Genetic testing is an insured service in BC when it is medically necessary to the medical management of the beneficiary's condition" Seems to me that the second clause would be applicable to the Oncotype Dx test - I have already contacted my MLA to see what kind of appeal process exists to challenge MSP. Next might also alert the press - how many women/men with breast cancer are being denied access to new technology that has been proven to be an accurate predictor of the efficacy of chemo??

Oops, I'm on my soapbox again..

Suki

Sukisez

Dear feb - what did you decide? Chemo or no chemo? And how are you now?

Hugs!
Suki

Anonymous

TAILORx is definitely not closed. I just attended a session on it this week w/ the lead of the trial. They are looking to enroll 5000 people in the trial - here's the existing trial locations

Sukisez

Wow, that's a pretty extensive test then - wish we could have the opportunity to join in Canada!
I am combing through provincial and federal health policy - appears the crux of this is that the Oncotype test is regarded as a "predictive" genetic test (not covered) rather than "diagnostic genetic testing of a symptomatic individual to aid in his or her diagnosis, treatment and management" (which it obviously is...)

Anonymous

Actually Onctotype (and a new similar one Mammoprint out of Europe - this one needs fresh, frozen tissue) is considered a prognostic tool. Prognostic factors are things like tumor size, lymph node involvement, nuclear features, hystologic grade. Predictive factors include ER/PR receptors, Her-2-Neu. These are from notes I took from an in-service training this week (I volunteer for Y-me and am a match peer counselor) - the speaker was the doctor who is heading up the TAILORx trial.

The premise for TAILORx is to reduce chemotherapy overtreatment and to Improve inadequate treatment - to evaluate the benefits of chemo in the mid-range group of Oncotype DX scores.

I hope some of this info will help you convince them that it is not a predictive genetic test.

I'd also encourage you to phone genomic-health re: the Oncotype test and see if they can help you - they may know of others from Canada and how those requests were handled. It's definitely worth pursing.
Doreen

jonimb

I'm sorry I gave you some inaccurate information. I didn't mean to send you on a wild goose chase.

Joni

Dragonfli

Hi Ladies,

I am 3 years out from my last chemo treatment as of March 2,2007, and I thought I would add my 2 cents to this topic.
This is just my own personal opinion, but I sat here thinking of the ramifications of an onco-type gene test.
If I was newly dx & thought I would benefit from chemotherapy, would my choice be taken away if I scored low on this test?

I totally understand the frustration with being in Canada and not always being able to receive the same tests and treatments as out US neighbors do, but we do have an amazing health system in Canada when it comes to Cancer. I cannot imagine what it would be like to have to pay all or even a tiny portion of my chemotherapy or surgical procedures. We are still so very fortunate here.

I do think it is still necessary to question the differences in treatments and tests, we all need to advocate for breast cancer and all the different treatments and choices.

I personally sailed through my chemotherapy with close to no side effects on FEC100 6 x. I was given Neupogen as well from treatment 3 onwards.

I would hope that this test, would never take away ones choice to be able to decide if chemotherapy was right for their treatment protocol.

Just my thoughts.
Hugssss
Barb
www.breastcancersisters.ca

hi5-2006Aug13

Suki: I did not have chemo... even though I was on the borderline it was determined that I didn't require it. I did ask about the oncotype test which, I understood, was a determinant of whether or not chemo would be a benefit and was told no oncotype here.

Oncotype is NOT a genetic test. I just got my results back on Friday that I do have the BRCA1 gene so another round of testing and surgery. I am the third of 4 sis to have bc.... my sis' 3 daughters just found out the previous week that they ALL tested positive for the gene!!!!
They do not do genetic testing unless there is a family history.

Sukisez

Hello ladies ..

Well saw rad. oncologist today - wants me to see surgeon again to go back in to as margins are too close. This would be surgery #3 since Feb 20 - 1st lumpectomy, 2nd massive hematoma drained on Mar 3 - and now back in to clean up margins.
I am thinking of building a teeny tiny toll booth out of toothpicks and glue and placing it on the incision site - considering the traffic through that breast; may as well start charging!!
And of course, they are going to conference my case as to whether or not chemo required - the oncotype test (which is defined as Procedure Code S3854, definition: "genetic expression profiling panel of use in management of breast cancer treatment" would (if it were available in Canada) examine 21 gene characteristics within the BC sample to determine it's aggressiveness and this is relayed to the oncologist and patient as a probability percentage that it will reoccur within 10 years. It is a tool in the decision making process; I see no indication in the stories I have heard from US Oncotype recipients that anyone has ever been forced to either have chemo or been denied chemo as a result of the test results; the decision is still in the patient's hands...

Hang in there y'all!!

Suki