Breast cancer and Medicare funded testing in Australia

Testing criteria for Medicare item number 73296 were updated at the end of 2023.

Medicare funded (bulk billed) testing is now available for all individuals, regardless of their current age, if they have been diagnosed with:

Breast cancer at or before age 40.
Triple negative breast cancer.
Male breast cancer.
Metastatic breast cancer.
Breast cancer and are Ashkenazi.

To be bulk billed, the test must be ordered by specialist (such as a Genetic Oncologist) or a consultant physician, not a GP.

The test, called a germline genetic test, should not be limited to just BRCA1 and BRCA2. It should include other moderate or high risk breast and/or ovarian cancer genes such as ATM, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, PALB2, PTEN, RAD51C, RAD51D, STK11 and TP53.

Another change to the updated Medicare criteria is that more breast and ovarian cancer risk genes can be included in the risk models such as CanRisk. This makes it easier to meet the 10% cut off needed for bulk billed testing. This is great news! It also mean that some patients who were told they weren't eligible in the past, may now meet these more generous criteria.

Predictive Genetic testing for Breast Cancer risk genes

If a pathogenic (disease causing) mutation has been found in a blood relative, your "predictive" testing is available to see if you carry the same mutation. Testing is usually Medicare funded. This is true even if the mutation was detected in a cousin and your parent and/or your aunt/uncle has not had testing.

Predictive testing criteria, under item number 73297 have also also been updated to include more genes associated with a moderate or high risk of breast cancer.

Predictive testing is important as it can help guide screening recommendations, particularly in relatives who have not had cancer. It may also mean that more sensitive forms of screening, such as breast MRIs, are also bulk billed.

Medicare funded predictive testing is now available for the following genes:

Medicare funded predictive testing is still available for

See our Genes page to learn more about these genes and their implications for individuals and families.

These genes are genes that we all carry - we inherit them from our parents. It's when they are not working , due to a mutation (pathogenic variant), that the risk of cancer goes up. Fortunately, if you know you are at increased risk, there is a lot you can do about it.

This may include:

starting screening earlier

using more sensitive screening techniques (such as breast MRI, and this may be bulk billed)

taking risk reducing medications

surgery (especially if screening doesn't work, such as in ovarian cancer)

prevent the mutation being passed on (via IVF and PGD)

Some of these genes only seem to increase the risk of breast cancer. Many also increase the risk of other cancers such as ovarian, pancreatic and prostate. You can read other circumstances in which Medicare funded genetic testing is available here. Knowledge is power!