1. Research Brief: Genetic Testing for Hereditary Cancers Craig Morse BIO 101 SNHU

2. Expanding the Affordable Care Act’s Requirements to Cover Genetic Testing for Those Already Diagnosed with Cancer.

3. Summary

4. History: 2005 – USPSTF provided grade “B” recommendation for BRCA testing to select group of women. ACA mandates recommendations grade “A” or “B” by USPSTF must be covered without cost-sharing CONCERN: This recommendation does not include women who have already been diagnosed with breast and/or ovarian cancer.

5. What is BRCA? BRCA1 and BRCA2 Up to 87% lifetime risk for breast cancer A 40-60% risk for a second primary breast cancer Up to a 45% lifetime risk for ovarian cancer Identify individual = changes to medical management Incidence of mutation carriers = 1:400

6. Issues

7. Issue The ACA’s benefit for BRCA testing does not include women who have been diagnosed with breast and / or ovarian cancer. ASCO NCCN ACMG 2013 USPSTF – “out of their scope”

8. Recommendations

9. Recommendation The U.S. government should expand the Affordable Care Act to include coverage for BRCA genetic testing in women who have already had a diagnosis of breast or ovarian cancer. Like the coverage for those meeting USPSTF guidelines, this coverage should exclude cost-sharing.

10. Reasoning

11. Arguments For Preventing a new diagnosis is more cost-effective than treating it Reduce mortality Arguments Against Genetic Testing is Costly $2000-4000 genetic test Prophylactic surgery Reduced imaging/follow-up Cancer diagnosis Surgery Chemotherapy Radiation Years of follow-up

12. Implications

13. Conclusions Expansion of the Affordable Care Act’s Requirements to Cover Genetic Testing to Include Those Already Diagnosed with Cancer will result in: Potential for reduction of healthcare dollars Potential for reduction in cancer incidence Potential for reduction in mortality

14. References Affordable Care Act Implementation FAQs – Set 12. Centers for Medicare & Medicaid Services. Available from: http://www.cms.gov/CCIIO/Resources/Fact- Sheets-and-FAQs/aca_implementation_faqs12.htmlhttp://www.cms.gov/CCIIO/Resources/Fact- Sheets-and- Kroger, J. and A. Park (2013). The Angelina Effect. Time. May 27. Accessed from: http://content.time.com/time/covers/0,16641,20130527,00.html Moyer, V.A. (2014). Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014;160:271-281. Petrucelli N, Daly MB, Feldman GL. BRCA1 and BRCA2 Hereditary Breast and Ovarian Cancer. 1998 Sep 4 [Updated 2013 Sep 26]. In: Pagon RA, Adam MP, Ardinger HH, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2014.Available from: http://www.ncbi.nlm.nih.gov/books/NBK1247/ U.S. Preventive Services Task Force. Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. (2005). Ann Intern Med 143:355-61.