Many Americans are facing sharp increases in health insurance in 2014; thus, raising concern regarding the affordability of healthcare in upcoming years. However, one bright spot is on the horizon, the price of a popular test for breast and ovarian cancer is expected to drop. The genetic test for the BRCA1 and BRCA2 mutations is recommended for women with a family history of breast, ovarian, and some other cancers. According to the National Cancer Institute, women who carry the BRCA mutation have an approximately 10% risk of developing breast cancer and a 15% risk of developing ovarian cancer. Thus, a negative test result provides reassurance, while a positive test, although disheartening, can be of benefit. Women with a positive result can undergo increased surveillance and even consider removal of ovarian or breast tissue.
The test, manufactured by Myriad Genetics, is a big-ticket item. Medicare currently reimburses $2,795 for the test; however, beginning January 1, 2014, Medicare will pay a maximum of $1,440, marking 48.5% price cut. Medicare beneficiaries represent a small portion of individuals who undergo the test; however, healthcare analysts note that private insurers generally use the Medicare reimbursement rates as yardsticks from which to base their own rates. The list price of the test is even higher; Myriad charges $3,340 for its most-comprehensive BRCA test; however, though the amount actually paid differs depending on the discounts negotiated by individual insurers. For example, Quest Diagnostics, a nationwide provider of diagnostic tests, currently offers the test for $2,500.
The price cut was prompted by a US Supreme Court ruling last summer that invalidated Myriad's patent rights to the BRCA genes and ended the company's monopoly over testing for BRCA mutations. After the ruling, other diagnostic laboratories, including Ambry Genetics and Quest Diagnostics Inc., began offering their own BRCA mutation tests, often priced significantly below Myriad’s rate. The Centers for Medicare and Medicaid Services, which announced the price drop, notes that with the new price competition, the cost of BRCA testing has decreased to a range of $900 to $2,900, depending on the laboratory.
According to the Los Angeles County Department of Public Health, breast cancer is the leading cause of premature cancer death in the county. Excluding cancers of the skin, breast cancer is the most frequently diagnosed cancer in women. The American Cancer Society estimated for 2013 that about 232,340 new cases of invasive breast cancer would be diagnosed in women in the US. In addition, during 2013, 64,640 new cases of carcinoma in situ (cancer that has not spread beyond the original site) was estimated to be diagnosed, primarily (about 85%) ductal carcinoma in situ. In 2013, it is estimated that 2,240 men will be diagnosed with breast cancer.
Year 2013 estimates include 40,030 deaths occurring from breast cancer in the US alone. This includes approximately 39,620 women and 410 men.
In addition to a family history and/or carrying a BRCA mutation, the following are risk factors for ovarian cancer:
- Age (over the age of 55)
- Hormone replacement therapy. Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.
- Infertility (inability to become pregnant)
- Personal history of breast or colon cancer
- Certain fertility drugs