When Rebecca Munoz was diagnosed at age 29 with breast cancer in 2017, it was a confusing time. She discovered her lump by accident. She knew nothing about breast cancer treatment and biomarker testing or anything that could improve her outcome.
“It’s almost like a bomb has been dropped on you,” she said. “I thought it was a death sentence.”
She went through six rounds of chemotherapy, a double mastectomy and then immunotherapy before being cancer free.
Munoz was lucky. The biopsy from her tumor was sent for biomarker testing, which looks at the genes, proteins and other characteristics of that tumor to allow doctors to make more individualized and effective treatment decisions.
These biomarkers revealed that she had an aggressive form of breast cancer with the HER2 protein. She will need aggressive treatment.
Munoz didn’t have to do anything. Her doctors just did it for her. She had Blue Cross and Blue Shield insurance through her husband’s federal job and believes the tests were covered by that plan.
Not everyone with cancer is so lucky. Insurance companies, including Medicaid and Medicare, do not have to cover biomarker testing in Texas. The American Cancer Society notes that access to biomarker testing in Texas often depends on your insurance, whether you live in a rural or urban area, whether you were seen at a non-academic or medical school hospital, and your race.
“It’s amazing to witness the change in the standard of care,” said Dr. Debra Patt, a breast cancer specialist and Texas Oncology executive vice president who focuses on health policy and strategic initiatives. “However, people without insurance to cover the biomarker testing cannot experience this standard of care.” The most vulnerable patients don’t get it.’
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How can state law change this?
This session, the Texas Legislature is considering two bills that would require biomarker testing to be covered by insurance, including government plans such as Medicaid and the Children’s Health Insurance Program.
Senate Bill 989 is by Sen. Joan Huffman, R-Houston, and House Bill 3188 is by Congressman Greg Bohnen, R-Friendswood. They are identical and say: “The health benefit plan must provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of the enrollee’s disease or condition to guide treatment when the test is medically supported and scientific evidence.”
Some of the things that count as evidence are the Food and Drug Administration’s requirement that biomarker testing be done before receiving a drug or test, that coverage be approved by the Centers for Medicare and Medicaid Services, nationally recognized clinical practice guidelines and consensus statements from experts.
Texas would join Arizona, Louisiana, Illinois and Rhode Island with this law; in 16 other states, legislation has been introduced but not passed.
How much does biomarker research cost?
Pat said the testing costs about $1,000 out of pocket.
“Costs have gone down,” she said, noting that a few years ago they were $5,000.
Some of the testing companies have charity programs for people without proper insurance.
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Why is biomarker research important?
“Oncology care has evolved tremendously,” said Pat. She thinks back to 2006, when all non-small cell lung cancer patients received chemotherapy. Now, more than 50 percent have some kind of molecularly targeted therapy, she said.
The American Cancer Society provides these facts: 60% of oncology drugs launched in the past five years require biomarker testing before a patient can use them, and more than half of cancer clinical trials now include biomarkers.
Pat thinks cancer has locks and keys. Although there are many different keys – treatments – they may not be effective for this key – the very specific type of cancer.
“If we’re trying to open the door with an ax, it’s a blunt tool that affects all the cells, not an elegant tool,” Pat said, comparing treatments like general chemotherapy (the ax) to more precise, targeted treatments (the specific key).
By identifying biomarkers, Pat said, “I can give this therapy that will make them live longer and is less toxic.”
“The dream of modern cancer therapy is for them to live their own lives with the disease under control,” she said.
Pat has seen how these targeted therapies really change the life expectancy of the breast cancer people she works with. A person with metastatic breast cancer (cancer that has spread outside the breast) lived an average of five years after diagnosis. It’s been 16 years now, Pat said.
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Is biomarker testing just for cancer?
No. Biomarker testing is also used in the treatment of autoimmune diseases. More research is being done on how it can be used for heart disease, Alzheimer’s, sepsis, respiratory disease and infectious diseases.
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What is the difference between biomarker testing in individual patients?
Muñoz has a strong family history of cancer, including her grandmother, aunt and several uncles, all of whom died of the disease and had no biomarker tests.
“Nobody in my family has access to it,” she said.
Munoz, 34, is celebrating five years of being cancer-free. She said not only did the biomarker testing help her doctors identify the right chemo and immunotherapy, but it also gave her more confidence that the treatment matched her cancer and would work. It helped her get through the six rounds of intense chemotherapy needed to deal with her aggressive cancer.
“I’m here today because I had access to biomarker testing,” Munoz said.
Correction: This story incorrectly stated that Munoz’s mother and sisters had a history of cancer.