Calls have been made to expand NGS screening benefits for breast cancer to match those for lung cancer, as current funding varies by cancer type, to be expanded to cover breast cancer at the same level as lung cancer.
The Korean Cancer Association and the Korean Cancer Study Group made the call at a policy debate on “Breast Cancer, Discussing Ways to Improve Survival Rates and Minimize Socioeconomic Losses,” hosted by Rep. Seo Myong-ok of the ruling People Power Party (PPP), a member of the National Assembly's Health and Welfare Committee, on Monday.
Rep. Seo Myung-ok of the ruling People Power Party organized a debate titled “Breast Cancer, Discussing Ways to Improve Survival Rates and Minimize Socioeconomic Losses” at the National Assembly on Monday.
Rep. Seo Myung-ok of the ruling People Power Party organized a debate titled “Breast Cancer, Discussing Ways to Improve Survival Rates and Minimize Socioeconomic Losses” at the National Assembly on Monday.
In 2017, Korea became the first country to apply screening benefits for NGS testing, covering six blood cancers, 10 solid cancers, and hereditary diseases. In 2019, the government expanded the coverage to include six blood cancers and all advanced solid cancers stages 3 and 4 (with a 50 percent co-payment rate) and blood cancers and solid cancers stages 1 and 2 (90 percent co-payment rate) other than the six.
However, in December 2023, following a reassessment of screening benefits, the reimbursement criteria for NGS testing were significantly revised.
The government significantly reduced support, raising the co-payment rate to 80 percent for all advanced solid cancers except NSCLC, six major blood cancers, and hereditary diseases, and to 90 percent for other special cancer patients.
At the time, the Health Insurance Review and Assessment Service (HIRA) explained that the decision was based on expert advice, the level of clinical evidence accumulation, and the use of targeted therapies. However, cancer experts who participated in the re-evaluation criticized the decision as “backward thinking” and pointed out that it did not reflect their advice.
In response, HIRA said that even outside of the next reassessment cycle (three to five years), if clinical studies confirm treatment effectiveness, the panel can conduct an expedited review to adjust the co-payment rate downward, ending the controversy.
At Monday’s policy debate, cancer experts called for aligning NGS reimbursement for breast cancer with lung cancer. They maintained that the co-payment rate for NGS tests for stage 3 and 4 breast cancer patients should be reduced to 50 percent.
Professor Im Seock-ah of the Department of Hematology-Oncology at Seoul National University Hospital (SNUH) presented an analysis of gene panel tests performed at the hospital over the past seven years as evidence.
An analysis of 522 patients with locally advanced or metastatic breast cancer found that 40-60 percent had treatable mutations and showed improved survival rates with licensed targeted therapies or investigational new drugs.
The data was published in the online edition of Cancer Research and Treatment (CRT), an international journal published by the Korean Cancer Association, on Aug. 21, 2024.
“Overall survival (OS) was prolonged by two to five years in patients who received personalized treatment based on NGS results,” Professor Im said, emphasizing that NGS can help identify genetic mutations with appropriate targeted therapies in up to 60 percent of patients with metastatic breast cancer, and therefore needs reimbursement.”
The second speaker, Professor Park Kyong-hwa of Korea University Anam Hospital explained the role of NGS testing in precision medicine, compared global NGS coverage policies, and called for a revision of Korea’s reimbursement standards.
“Cancer treatment through precision medicine is a global trend and standard,” Professor Park said, stressing that genomic profiling is the first gateway to precision medicine.
Park noted that by identifying the characteristics of each patient's cancer tumor through genomic analysis, treatment effectiveness and patient quality of life can be improved, and efficiency and cost savings can be achieved.
“All clinical guidelines, Korean and foreign, recommend genomic testing in advanced cancers,” Professor Park said. “Korea was the first country to start covering NGS testing, but the level of coverage has completely reversed, with the U.S., Japan, and many European countries now supporting NGS testing through public insurance.”
“What's worse, the prognosis gap between stage 4 breast cancer patients in the U.S. and Korea is even starker in younger patients, which is a result of not receiving adequate targeted treatment,” Park said. “Identifying treatment opportunities through NGS testing is the least we can do for patients with advanced cancer who have limited time to live.”
Choi Seung-ran, president of the Union of Korean Breast Cancer Patients, participated in the panel discussion and echoed the opinions of cancer experts.
“The reduction in government support for NGS testing weighs heavily on breast cancer patients,” Choi said. “For cancer patients, NGS is not a question of whether to get tested or not but whether to live or die.”
Choi continued, “We can no longer allow the burden of paying for NGS tests to be a barrier to treatment. We urge the government to reduce NGS test costs for breast cancer patients to match those for lung cancer.”
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Kim Yun-mi kym@docdocdoc.co.kr
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