The cost impact of unselective vs selective MammaPrint testing in early-stage breast cancer in Southern Africa

Abstract

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Impact of the genomic signature of 70-genes for breast cancer in the public system and in supplementary health care in a country of medium socioeconomic development

“…They also experience delays in starting treatment and barriers to accessing gold standard therapies [ 23 , 25 ]. Thus, the 59.8 % downgrading of the indication for adjuvant chemotherapy using the genetic signature could represent a bridge towards reducing the social impact of breast cancer treatment in low- and middle-income countries [ 13 , 26 ], without harming distant metastasis-free survival [ 6 ].…”

Pioneering BRCA1/2 Point-Of-Care Testing for Integration of Germline and Tumor Genetics in Breast Cancer Risk Management: A Vision for the Future of Translational Pharmacogenomics

“…The results obtained in this study supports incorporation of germline BRCA1/2 testing early in the treatment planning of all BC patients in SA ( 18 ), including those opting for gene profiling using MammaPrint. Although MammaPrint is not available to BC patients in the public sector at present the prioritization of clinically high-risk patients for testing, such as those with node-positive ( 1 – 3 ) early-stage BC, could result in safe avoidance of chemotherapy and its associated side effects in approximately 50% of eligible BC patients ( 37 , 41 ). By performing the BRCA 1.0 POC Research Assay in conjunction with transcriptional gene profiling, unnecessary medical expenditure may be further reduced.…”

“…Although expensive, tumor gene profiling is currently reimbursed by private medical schemes in SA after careful patient selection using tools such as the MammaPrint pre-screen algorithm (19). The cost-benefit potential of selective MammaPrint testing was recently confirmed in a study of approximately 600 tumor samples of SA patients with early-stage BC, by employing a chemotherapy de-escalation strategy through clinical risk stratification (41). While toxicity profiles make hormone therapies an attractive option, the standard of healthcare on the African continent is reflected by the lack of ER, PR and HER2 assessment in many state institutions managing the disease (3,42).…”

A View on Genomic Medicine Activities in Africa: Implications for Policy

“…The slow pace of adoption of novel findings largely relates to poor understanding of the role of genomics in risk stratification and targeted treatment. Practice-changing solutions require inventive steps which demonstrate clinical utility beyond standard pathology tests, as evidenced in the surgical oncology field using a cost-minimization pathology-supported genetic testing strategy ( Mampunye et al, 2021 ; Myburgh et al, 2021 ). Incorporation of omics solutions into existing treatment algorithms is therefore needed to prevent misdirection and fragmentation of genetic services relevant to individual patients or their healthy, at-risk family members ( Solomon et al, 2011 ; Moremi et al, 2021 ).…”