Cancer Testing – A Tough Call

The news that Angelina Jolie had undergone genetic testing to identify the likelihood of her contracting breast cancer, and that she had subsequently decided have an elective double mastectomy and reconstructive surgery, raised many questions. But Jolie’s decision also raised awareness.

Until they read the headlines about Jolie’s tests, many people were simply unaware that this option existed. Now, the debate around genetic testing has risen once more to the surface, as NHS England is due to announce the results of a review to cut the cost of cancer treatment, and specifically the costs faced by the Cancer Drugs Fund.

There has been much discussion over the best ways to reduce costs when concerning cancer. One idea is that predictive testing for hereditary illnesses, such as risks that can be identified BRCA1 and BRCA2 tests, then taking clinical action where it is deemed helpful, reduces the likelihood of getting cancer – and therefore cuts the costs of necessary treatment.

For example, a woman who contracts breast cancer may require a range of treatment, such as lumpectomy, chemotherapy, radiotherapy, and drugs further down the line, and this could cost hundreds of thousands of pounds. Supposing the type of cancer she has could have been predicted, to a degree, through genetic testing; she might have taken the decision to undergo surgery to reduce the likelihood of getting cancer. Genetic tests followed by, if they reveal a high chance of breast cancer, elective surgery, would cost in the tens of thousands. And so, following this logic, genetic testing and surgery, where it’s deemed useful, could cut costs.

That is a very simplistic way of looking at the matter and it is, of course, an extremely tough call. The NHS and private medical insurers have yet to come down firmly on one side of the fence when it comes to cost. But increased awareness of the subject has raised concerns in individuals who are worried their genetic makeup could put them at greater risk of getting certain types of cancer. It is certainly a subject we are being asked about by our clients on a more frequent basis. People understandably want to know where their PMI provider stands on the matter of genetic testing.

Would genetic testing be covered? Would any subsequent treatment be covered?

AXA-PPP recently clarified its position on the matter by saying it would not be covering either the tests or the treatment that may be decided on based on the results. The decision is interesting – and at odds with other areas of the market. Many insurers are not quite as explicit over what they will or will not cover under policies – it is a question that needs to be asked on an individual basis. But Bupa has said that it will look at this matter case-by-case, and in essence it will cover tests as well as the elective surgery that may be chosen based on the results. It’s not entirely clear whether reconstructive surgery would be covered, but in the event that psychological damage could be suffered, it may well be. Again, it is a case-by-case matter.

Whether AXA-PPP retains its stance over not paying for genetic tests or elective surgery based on the results of tests remains to be seen. If it can be shown that testing and preventative measures reduce treatments costs significantly when compared to the ‘wait and see’ approach, perhaps it will revise its decision. But for now, if a client’s priority is to select an insurer that will cover genetic tests, then Bupa ticks a great many boxes.

If you would like advice on the matter of genetic testing and where your provider stands on this, please do not hesitate to contact Chris Bromilow on 020 7353 4099.