Sydney Cancer Genetics

Eligibility for Medicare funded (bulk billed) testing in breast cancer has been expanded but is causing confusion among patients and doctors.

What are item 73295 and item 73296? Who is eligible and when should you test?

The executive summary is:
• use item 73296 at diagnosis if the individual with breast cancer meets the 10% likelihood criteria (includes all triple negative breast cancer, breast cancer < age 40, male breast cancer, all metastatic breast cancer or if there is Ashkenazi heritage and breast or ovarian cancer)
• use item 73295 after surgery in ER positive HER2 negative patients who have 4 or more positive lymph nodes who will be having adjuvant chemotherapy (chemotherapy after surgery) and who would be considered suitable for Olaparib if BRCA positive
• use item 73295 in ER positive HER2 negative patients post neoadjuvant chemotherapy (neoadjuvant = chemotherapy given before surgery) if there is residual disease after surgery and they are considered suitable for Olaparib if BRCA positive
• use item 73295 in ER positive HER2 negative patients during neoadjuvant chemotherapy and before surgery after discussion and agreement at an MDT that the patient has high risk disease (at least grade 3 or 1 node or >2cm) AND would be suitable for Olaparib AND is likely to have residual disease post chemotherapy AND it is unlikely that a result would be available in a timely manner (12 weeks) if testing were to be delayed until post surgery.
• Do NOT use item 73295 if the patient is not suitable for either chemotherapy or Olaparib.

The best way to think about these item numbers is that item 73295 is used when there is a newly diagnosed breast cancer and treatment options are being considered.

By contrast, item 73296 is based on the diagnosis of breast cancer It relates to personal features such as the age of diagnosis (not the current age), the type of cancer diagnosed as well as family history and Jewish heritage.

The following groups have a clinical risk of >10%, according to research. Note: this is independent of family history and the patient’s current age:
• Diagnosis of invasive breast cancer at or before age 40
• Metastatic breast cancer at any age
• Triple negative breast cancer at any age
• Ashkenazi heritage and diagnosis of breast cancer
• Male breast cancer at any age
• ovarian cancer at any age (high grade serous, clear cell or endometrioid)

If you were told in the past that you were not eligible for a test, or perhaps had limiting testing of just BRCA1 and BRCA2 before 2017, you may be eligible today. If you think that is the case, discuss your personal and family history with your doctor.

A more detailed discussion about these item numbers and who is eligible can be found on our website's FAQ page under the topic "Will I get a genetic test?" or you can follow the link:

Will I get a genetic test? - Sydney Cancer Genetics At Sydney Cancer Genetics a cancer genetic testing assessment often results in reassurance and less screening.

More great news: MBS item 73297 now states predictive testing is available for “genes associated with breast, ovarian, fallopian tube or primary peritoneal cancer”. (“Predictive” testing is performed when a pathogenic mutation (Class 4 or 5 variant) has been detected in a blood relative. It just tests for that specific mistake.)

This means that families can now access bulk billed testing of ATM, CHEK2, BARD1, BRIP1, RAD51C and RAD51D. In the past, testing was limited to BRCA1, BRCA2, CDH1, PALB2, PTEN and TP53.

Testing is available for cousins as well as more distant relatives, not just brothers and sisters or offspring.

These genes all impact screening and risk management guidelines. It's another reason why the initial testing should include a full panel and not just BRCA1 or BRCA2.

Testing still needs to be ordered by a specialist or consultant physician. If you think you may meet these relaxed eligibility criteria, contact Sydney Cancer Genetics to make an appointment or speak to your treating specialist or local public familial cancer clinic.

Great news: more people can now access Medicare funded genetic testing! At the end of last year, the eligibility criteria changed.

Item 73296 has dropped the need for a “quantitative algorithm” to be used. So, who is eligible for bulk billed testing?

Using the clinical criteria (regardless of current age or family history):
• All men with breast cancer
• All individuals with breast cancer diagnosed at or before 40
• All individuals with triple negative breast cancer
• All individuals with metastatic breast cancer.
• All individuals with Ashkenazi heritage and breast cancer
• All individuals with high grade (2 or 3) non-mucinous epithelial ovarian cancer (includes serous, clear cell, endometrioid).

Also, using the family criteria, the number of genes that can be included in the 10% cut off has increased.

This means that individuals who didn’t meet the cut of using the simple Manchester score (which focuses just on BRCA1 and BRCA2), may be eligible if a more sophisticated model, such as CanRisk, is used.

CanRisk provides a likelihood for BRCA1 and BRCA2 but also provides a composite score using ATM, BARD1, BRIP1, CHEK2, RAD51C and RAD51D in addition to BRCA1, BRCA2 and PALB2.

Testing still needs to be ordered by a specialist or consultant physician. If you think you may meet these relaxed eligibility criteria, contact Sydney Cancer Genetics to make an appointment or speak to your treating specialist or local public familial cancer clinic.

The Annual BRCA information day will be hosted by Pink Hope this year. Dr Hilda High will be one of the speakers.

Date: Saturday 21st May, 2022
Time: 9am to 2:30pm
Location: 488 Kent St, Sydney
Registration: on the Pink Hope website. First in, numbers limited.
Cost: $25.

This is a great day, created to provide up to date information on cancer risk management for individuals who carry a BRCA mutation. Family and support people are also welcome. Speakers include doctors, counsellors and community members. It's a relaxed day with plenty of time to ask your own specific questions and network with other families.

For more information and to register, see the Pink Hope website: www.PinkHope.org.au

Pink Hope Pink Hope is a preventative health hub that provides our community with the necessary tools to assess, manage and reduce their risk of breast and ovarian cancer, while delivering free personalised support for at risk women.

The Federal Government has announced changes to Telehealth that will come into effect on the 1st of January 2022.

This will see the abandonment of Telehealth item 112 and many phone Telehealth item numbers.

Abandoning Telehealth Item 112 will cost rural patients money and maybe their lives.

Dr High has created a video to explain what this means for rural and regional patients and what you can do to help.

Please see:

Videos - Sydney Cancer Genetics At Sydney Cancer Genetics a cancer genetic testing assessment often results in reassurance and less screening.