Genetic testing for hereditary breast and ovarian cancer to be subsidised

SINGAPORE: Singaporeans at high risk of hereditary breast and ovarian cancer (HBOC) will have access to subsidised genetic testing from December, the Ministry of Health (MOH) said on Thursday (Mar 5).

Eligible Singaporean and permanent resident patients can receive means-tested subsidies of up to 70 per cent for the genetic test. Seniors from the Pioneer and Merdeka generations qualify for additional subsidies on top of that.

Patients can use their MediSave to cover remaining costs after subsidies, and those aged 60 and above may use Flexi-MediSave to further reduce out-of-pocket expenses.

About one in 150 Singaporeans carries a mutation in HBOC-associated genes, which significantly raises their risk of developing breast and ovarian cancer.

Women with such gene variants face a lifetime breast cancer risk of up to 60 per cent and an ovarian cancer risk of up to 50 per cent, compared with up to 13 per cent and up to 2 per cent respectively in the general female population.

MOH said the full suite of HBOC interventions – from genetic testing to follow-up treatment – has been assessed as both clinically and cost-effective. Further details on financing support will be released later this year.

The move is part of broader efforts to strengthen preventive care and precision medicine, said MOH. Last year, the ministry launched a national genetic testing programme for familial hypercholesterolaemia, a hereditary condition causing high cholesterol.

Speaking in parliament on Thursday, Health Minister Ong Ye Kung said the ministry expects over 2,000 individuals to be eligible for the HBOC genetic test annually.

“For those found to have the mutation, they will be offered suitable preventive interventions, typically this means more frequent breast MRIs or mammograms, or oral medications,” he said.

“Patients will ultimately decide, in consultation with their doctors, which intervention is appropriate. A minority may opt for surgical interventions,” he added. 

MEDISHIELD LIFE TO COVER RISK-REDUCING SURGERY

Beyond testing, MOH will extend MediShield Life coverage to selected risk-reducing surgical procedures for patients who test positive for HBOC.

Currently, such preventive surgery is subsidised but not covered by MediShield Life or MediSave. 

“With advances in medical science, the boundary between preventive and curative care is increasingly blurred. If a high-risk individual is unable to undergo preventive mastectomy, she has a high chance of eventually needing cancer treatments, including a curative mastectomy to remove ... cancerous tissues in her breast,” said Mr Ong.

MediShield Life should therefore be extended judiciously to cover certain preventive surgical procedures, he added.

“We are prepared to do so when there is a clear clinical need, minimal risk of abuse, the procedure is suitable for risk-pooling through insurance, and it does not financially burden the MediShield Life scheme.”

Following consultations with the MediShield Life Council, the ministry will extend coverage to preventive surgery that is medically indicated, high-cost but low-incidence, and cost-neutral or cost-saving to the insurance scheme.

For HBOC patients, this will include risk-reducing mastectomy, which involves surgical removal of the breasts, and risk-reducing bilateral salpingo-oophorectomy, which removes both the fallopian tubes and ovaries. 

MediSave use will also be extended to cover the remaining co-payment for these procedures.

Coverage for risk-reducing mastectomy is targeted for the third quarter of this year, with bilateral salpingo-oophorectomy expected in the fourth quarter.

MOH said it will continue to assess other forms of preventive surgery for MediShield Life coverage on a case-by-case basis, to ensure any expansion is carefully scoped and premiums remain affordable.

Editor's note: This article has been updated to amend information about the risk of Singaporean women developing breast and ovarian cancer after the Ministry of Health corrected information it originally provided. For the general female population, it is up to 13 per cent risk of breast cancer and up to 2 per cent risk of ovarian cancer.