Legislative fix will improve access to cancer screenings, preventative surgeries, and save lives

WASHINGTON – U.S. Senators Ben Cardin (D-Md.) and Lisa Murkowski (R-Alaska) introduced the Reducing Hereditary Cancer Act, legislation which would expand Medicare to cover screening for hereditary cancer for individuals with a family history of hereditary cancer.

Harmful changes in some genes or variants are known to be associated with an increased risk of developing cancer. Research indicates that inherited variants may contribute to about 5 to 10 percent of all cancers. Genetic testing can be used to determine whether family members have inherited a variant that is known to increase the risk of cancer. 

“Early detection can be the difference between life and death with a cancer diagnosis,” said Senator Cardin. “Medicare’s current restriction on genetic testing for hereditary cancers is out of step with the current science and practice. We have an obligation to ensure individuals with a family risk of cancer have access to key cancer screenings that give individuals a competitive edge in the fight of their lives.”

“Early cancer screening and diagnosis is critical to improving quality of life and survival rates. This legislation creates a path forward for greater testing and preventative surgeries—a real opportunity to help save lives,” said Senator Lisa Murkowski. “I am introducing this legislation after hearing from an individual from Fairbanks, Alaska whose own experience with cancer in their family led them to seek these diagnostic tests. That person’s family was fortunate to have access to the tests, but I want to ensure more Alaskans have the same opportunity. This legislative fix ensures that anyone covered by Medicare has the same access to these diagnostic tests.”

“This bipartisan bill will improve early detection of hereditary cancers and allow focused, enhanced preventive strategies to reduce unnecessary pain, suffering, and death,” said Robert W. Carlson, MD, Chief Executive Officer, National Comprehensive Cancer Network® (NCCN®). “Medicare beneficiaries deserve access to the same standard of preventive care and early detection as Americans with private insurance. We applaud the sponsors of the ‘Reducing Hereditary Cancer Act’ for taking action to ensure Medicare recipients have equitable access to health care that follows the latest evidence-based guidelines. Providing genetic testing for people with familial risk of cancer, followed with appropriate screening and risk-reducing interventions, will save lives and avoid future costly treatments.”

“We’re proud to be a key contributor to the effort to remedy this long-standing Medicare coverage gap. Private insurers and the many Medicaid programs cover medically necessary genetic counseling, testing, screening, and preventive services,” said Lisa Schlager, Vice President of Public Policy at Facing our Risk. “Medicare beneficiaries with a hereditary predisposition to cancer deserve the same evidence-based care to prevent or detect cancer earlier, when it is easier and less expensive to treat. People with inherited genetic mutations, such as BRCA, ATM or Lynch syndrome, are the poster children for prevention. Ultimately, lives and money will be saved—and health disparities will be reduced!”

Bill Details:

The bill would add Medicare coverage for the following:

• Genetic testing for germline mutations – In the case of an individual with a person or family history of a hereditary cancer gene mutation or a personal or family history suspicious for hereditary cancer. Limited to once per individual.
• Risk-reducing surgeries – In the case of an individual for whom, based on evidence-based guidelines, surgery would reduce the risk of developing cancer
• Increased preventative screening frequency – In the case where genetic testing has determined that an individual has a hereditary cancer gene mutation, increased frequency for evidence-based screenings, in compliance with National Comprehensive Cancer Network guidelines or as determined by the Secretary, but no less frequently than on an annual basis. This provision is to address cases where an individual may test positive for the genetic predisposition, for example for breast cancer, but choose not to have preventative surgery.

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