BCI / Breast Cancer Index test?

gemini4

I just came across a mention of his test in another thread here, and it's the first I've heard of it. I visited the website but didn't learn much in terms of whether this test would be offered to me. I'm three and a half years into tamoxifen -- my MO said I'll probably be on hormone therapy for the full ten years at my last appointment.

What can you all tell me about this test? Is it expensive/controversial? I'm assuming the tumor is tested -- is that true? If so, is the tumor still available somewhere (nearly four years post-surgery)? I will of course ask my MO when I see her next in February, but I get all my information here first. :-

SpecialK

The BCI test from Biotheranostics is a genetic assay test that looks at some specific pathways that help determine whether hormonal therapy is likely to provide benefit beyond the five year point. The testing is done on your original tumor when you have reached the five year point, and gives information on both future recurrence risk and likelihood of effectiveness of the drugs themselves. Most pathology labs do store your tumor, mine was still available for testing and my original surgery was November of 2010, and I had the BCI test done last December. The test is fairly new, but is Medicare approved although not FDA approved, both of which are determinants for some insurance companies for coverage. My own insurance did not cover the test, but Biotheranostics has an insurance department devoted to appealing to insurance and if they exhaust that process with no payment, the patient is not responsible for the bill. The cost off the shelf is in the $5,000 range - as are Oncotype Dx and Mammaprint, and if the patient is uninsured or underinsured, the do have a patient assistance payment program. Many oncologists feel that if the patient scores high on the recurrence risk aspect of the test it is worth keeping them on anti-hormonals, regardless of whether the test shows drug benefit. I fell into the 10% of results that indicate high recurrence risk, but low benefit - and my MO asked me to stay on Femara if I can because low benefit is not necessarily zero benefit. Tamoxifen has more definitive study results at this point for continuing beyond five years, but the BCI test indicates the number who really do benefit is relatively low. Not all oncologists are on board with this test, and feel it is too new to be relied on without factoring other individualized clinical features for each patient. Your own MO, as many seem to, may feel that 10 years of hormonal therapy is the new guideline and may not feel that the BCI test is needed.

NatsFan

Gemini - As SpecialK said, this test is not offered till you reach the 5 year point, and is designed to identify those who will benefit from an additional 5 years of hormonal therapy. I had the BCI test when I was 8 years out and my tumor was still available for testing. I also expressed concern about whether the tumor would still be available for testing, but my MO said they keep them for decades, and that's how they can do a lot of these retrospective studies. My insurance covered the cost in full. Like SpecialK I fell into the high recurrence risk category, but I was different in that I also fell into the high benefit category. I had stopped letrozole at the 5 year mark, but based on my BCI results, I concurred with my MO's recommendation and am back on it for 2 years.

You're only 3.5 years in - things may change by the time you reach your 5 year mark. If it proves to be useful, my guess is that as time goes on, more insurance companies will cover it and more MOs will recommend it.

farmerlucy

Special K and Natsfan - what is the results range ex: 1 - 10, do they give you two separate numbers? What is considered high/low. Thanks! I too come here first Gemini!

NatsFan

Hi Farmer - You get two results. The recurrence risk was on a scale of 1-10. (I was an 8.8. ) The benefit assessment was just ranked High or Low, with a scale showing the difference in recurrence rates for those who don't continue on therapy and those who do.

There's a sample report on the BCI website: https://www.answersbeyond5.com/files/testreports/a...

farmerlucy

Thanks Natsfan! Guess I didn't look hard enough. 8.8 hmmm - what a mind bender. Ugh.

BCThe gift that keeps on giving.

NatsFan

"Ugh" is exactly how I felt when saw my results. Oh well - at least I got three years off! If it had been less definitive I might have skipped it, but there was just no way around that number. And although it was a shock at first, I was really glad to know. I can accept that there's a real reason to go back on it - not just that my MO is being overly-conservative, has a feeling about it, or recommends 10 years to everyone as a standard practice. It's made compliance much easier.

SpecialK

My score was very similar to natsfan, and I agree that knowing makes it easier to accept continuing on Femara because I can now see why through the lens of potential risk more clearly with confirmed testing.

radgal

I had the Breast Cancer Index Test done.

I was diagnosed last year in July and had surgery on 8-25-2016.

I wanted to know now if there would be any benefits with taking Tamoxifen.

I fall into the low risk of late recurrence category.

My insurance company said during three separate phone calls that they would cover the cost of the test. When I received the EOB, they denied it. I called them and explained to them when I called and that they said it would be covered. At present, Biotheranostics has resubmitted the claim using the new CPT codes my insurance company recommended. I am awaiting the results.

gemini4

Thank you for all the replies! It now makes sense to me. I'm interested in learning my recurrence risk score ... but only if it falls in the low category! ;-) As much as I don't like the side effects I feel from tamoxifen (and as much as I dread the upcoming SEs I'll encounter when I switch to an AI probably next year), I do have a sense of security by continuing the hormone therapy.

radgal

My oncotype score was a 2. My MO said he'd never seen a score so low. I initially planned on taking Tamoxifen until I read about all the side effects. Then I read about the side effects of AIs and those scared me too.

When I heard about the BCI test, I went to the website and read as much as I could. I actually spoke to one of the doctors who developed the test because I wanted the test done on me yet I had just had my surgery 3 months prior.

My reasoning was this...since the test is done on the tumor tissue from the surgery itself, why can't I have the test now to see what the score is? They're testing the tumor excised from my surgery; as such, it didn't seem to matter if the test was done now or 5 years from now. This way, my rationale was that if I showed a high recurrence rate, I would take the Tamoxifen.

Basically I was using that test to help me determine the chances of recurrence. In my heart, I was really scared of all the side effects and I knew my MOs wouldn't support me not taking them especially since it is the Standard of Care for them to prescribe it.

Since the test said I have a really low recurrence rate and since my Oncotype score is low too, I chose not to take Tamoxifen or AIs.

It has been over a year now and my bilateral mammogram in August was clean.

It was a hard decision and one that I didn't make lightly. The BCI test definitely helped sway me.

Here is the link for the Breast Cancer Index test at Biotheranostics with information for both patients and health care providers:

https://www.breastcancerindex.com/

Jennie93

Interesting. The site says that the test is used for women who are either node-negative or have 1-3 positive nodes. Does that mean they won't do it if you have more? My 4th was just a few microscopic cells, the MO didn't really consider it "positive", but said it made no difference because the recommendations are the same whether it's 3 or 4, anyway.

farmerlucy

http://www.baltimoresun.com/health/blog/bs-hs-brea...

Just saw this Re: new free app/ tool developed by Johns Hopkins to estimate recurrence. Could not find a link to the app though. Hmmm. Will keep looking.

http://www.breastrecurrenceestimator.onc.jhmi.edu/

Found it!

SpecialK

jennie - it usually means that the data collected on test accuracy is tied to those parameters, but it is up to your MO whether to submit the tumor sample for testing. I don't think that Biotheranostics would refuse to test, or possibly even know your nodal status. One thing I can say is that everyone I know who has had the test done and was node positive came back high recurrence rate.