Signatera Test. Is it truly helpful and worthwhile?

@briarrose I had first draw a week ago so, yes, anxious but also nervous. Going for consultation with medical oncologist closer to home today.Not excited about radiation—left breast mastectomy, compromised lung due to pneumonia x3. Gotta convince me it’s worth it…

I asked my oncologist for the Signatera or a similar liquid biopsy to monitor any possible changes but she refuses saying insurance will not cover it. I am diagnosed with early stage invasive ductal carcinoma stage I-II (borderline). But the biology of my tumor indicates grade 3 (aggressive), and a high ki-67.

Does anyone know whether Medicare pays for Signatera or other liquid biopsies in "early stage" breast cancer?

I will add i went through a process to have it approved by my insurance. I ended up not having it done. Zip a year ahead to the last days of my older sister's life, and thinking i wanted to tell her to do more than the "cancer" number she followed from a blood test. Finish the chemo, get the freaking genetic test. Stop the wanting only healthy. You have ovarian cancer. I decided to have it done. I had not noticed if my insurance approved the Guardant reveal test but they did.
The fun thing it took over one month. All through June and into July, so i asked my nurse to please find out. Seems, the group did not look at my medical record as i had a Bone Marrow Transplant from a male donor. The guardant people told my provider they were concerned as i checked female but had X/Y chromosomes. Really? They did not ask questions? They kept my test and were able to very a negative result. It was noted that i will likely have another test in 3 or 6 months. It is like signa tera.
Oh yes, I had breast cancer, brca2 mutation and MDS. Five years from 1st diagnosis this last July.

@prarysky My test was paid for. I believe - and you must check this out - if you are "stage 3" Medicare will pay for it.
But, again, check this out for accuracy.

@buckokey Not sure what you mean by "worth it" ?
The radiation? Or the Signatera Test?
I was not a candidate for radiation. I had a bilateral mastectomy. Nothing to radiate.
But if not - it would have been a very tough decision for me to go with radiation...I have heart disease and the risk of damaging my heart further was high.

Medicare pays for Signatera if you are Stage II or Stage III. I agree that it’s nerve wracking waiting for the results, but I believe it to be another valuable tool in the box.

@briarrose Thank you for responding about this. It sounds as if my doctor was right and insurance would not pay for it. My stage is borderline I-II but my pathology grade is 3. Medicare is probably using the clinical stage, though I wish the pathological stage was also considered. Because grade 3 is the most aggressive grade, I'd prefer to use liquid biopsies to monitor rather than waiting for obvious physical ones.

@lpowell Thank you for responding. There seems to be agreement that Medicare will cover it based on the stage. As I replied to briarrose, my grade is 3 but my stage is on the cusp between I and II.

Hi! @prarysky :

I completely understand your worrying regarding the recurrence issue of cancers - even for patients with early stages. For this reason, my PCP and I decided to check my cancer antigen value in my blood regularly. We specifically check my CA 15-3 level in a quarterly blood test to assess how cancer is responding to my active BC treatment right after the surgery that took out the mass of BC. CA 15-3 fluctuations help doctors determine whether a tumor is stable, growing, shrinking or has recurred. I am grateful that this regular blood test provides me with peace of mind confirming that my current treatment plan is working so long as the level of CA 15-3 in my blood stays within normal range or declining. We also agree that should this cancer antigen level elevated in the future, we'll bring this matter to my medical oncologist for further investigation using other scanning tools.

Please check with your physician(s) for such cancer antigen tests, for example, they may prefer to check for CA 27.29. We chose to test for CA 15-3, because in addition to breast cancer, other diseases of cancer, such as: lung cancer and ovarian cancer are also linked to increased CA 15-3 levels. Sorry for such a lengthy note, hope this helps...

Better journey ahead and enjoy life with hope, peace and love!

Thank you for sharing this approach! I think I've asked my oncologist or PA about one of the CA tests but will need to see if I kept notes. Whichever one it was, they said it wouldn't be useful to me. Based on your more specific tests, I'm gong to look into it and ask at my next visit.

I think a lot of breast cancer treatment leans more on what insurance covers which doctors like to call "standard of care" or "evidence based." Don't get me wrong, I'm all for evidence, but what do you do when the evidence is stalled out because research can't keep pace with precision medicine.

My doctors often say that as far as early-stage breast cancer is concerned, liquid biopsies 1) could be wrong and 2) wouldn't change the current treatment being offered. And I say, yes BUT. But what about the possibility that with a positive finding more careful monitoring would be warranted with repeated liquid biopsies? Or what about repeating at least 2 liquid biopsies with negative results? And wouldn't it be helpful for hospitals or doctors to keep track of what they are finding by using these liquid biopsies. It seems we, as breast cancer patients, are a huge database just waiting for someone to explore variables. Again, we come back to research funding though.

Again, thank you for sharing this important information!