Mammaprint in the basic package: The test could have saved Sabine from chemotherapy

From now on, basic health insurance will reimburse the costs for tests such as MammaPrint and Oncotype DX that can assess whether women over 50 need chemotherapy for early breast cancer. According to the Dutch Healthcare Institute, the tests can effectively predict the risk of cancer returning based on the number of genes present in the tumor. Usually, women with early breast cancer also receive chemotherapy after, for example, radiation or surgery.

Unnecessary health care costs

The tests are for women ages 50 and older who have early-stage breast cancer. The tests are expected to allow about 600 women a year to safely abstain from additional chemotherapy. Tests cost a maximum of €5,000 each, but chemotherapy often amounts to more than €15,000 per patient, according to calculations by the Healthcare Institute. So, if chemotherapy is not needed, this can save “unnecessary health care costs.”

Before Sabine was diagnosed with breast cancer in 2012, she had dense glandular tissue. It wasn’t often that she was necessarily concerned when she felt a lump, but she wasn’t so sure this time. “I was referred for a mammogram and it turned out to be a tumor.”

She had a hormone-sensitive variant without metastases to the axilla. Her left breast was amputated and she then received chemotherapy. “Chemotherapy attacks not only the wrong cells, but the good cells as well. It has short- and long-term side effects. My hair fell out, which is very obvious to others, and suddenly I looked different. I was often cold. Even in bed because “I wasn’t used to being bald.”

Numbness and pain in the joints

Sabine also felt that her face had become fatter and she had lost her sense of smell and taste. Going to the toilet was no longer intuitive, and she developed ulcers in her mouth. “During the first chemo, it’s not so bad and you feel rough. But at that moment you don’t realize that from the third treatment onwards, you feel like you’ve been run over by a truck.”

It’s now been eleven years and she still has many complaints. From tingling on her skin to joint pain. “The doctor told me this is some kind of shock. So much has happened that my body thinks at the slightest thing: This is going wrong and then sends pain signals.” Treatments in the hospital and with a skin therapist were not effective. These are the consequences that she has to slowly accept as consequences of chemotherapy.

Sabine believes it is “very good news” that breast imaging is now included in basic insurance, so that “hundreds of women will be exempted from chemotherapy.”

Medical oncologists are happy with the decision to now reimburse the testing costs. Five years ago they were disappointed by the Institute of Health Care’s previous decision, because chemotherapy was too stressful for patients. They are tired and often suffer from physical complaints. “If we can avoid all these side effects, this is good news for patients,” says Sabine Lin, MD, an oncologist at Anthony van Leeuwenhoek Hospital (AVL).

Less overprocessing

The AVL has previously calculated that 1,000 women between the ages of 40 and 70 are eligible for breast imaging, a slightly smaller group than those currently eligible for the reimbursement.

Lin: “But hormone-sensitive breast cancer is more common in women over 50. Through testing, we can identify one in two women who are currently receiving chemotherapy, but actually have a low risk of developing metastases.”