15/10/2024
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:
At Sydney Cancer Genetics a cancer genetic testing assessment often results in reassurance and less screening.
