DCIS Patients: Your Access to Biomarker Testing is at Risk – Take Action Today
Partnership note: I work closely with PreludeDX in my role as a patient advocate. This post was written as part of that relationship, and reflects both my advocacy work and my personal commitment to supporting DCIS patients.
Biomarker testing has been a game-changer in breast cancer treatment.
For years, tests like Oncotype and MammaPrint have helped women with invasive breast cancer understand their tumor biology, weigh treatment options, and make informed decisions alongside their doctors. These tools are part of the standard of care—and typically covered by insurance—because they provide powerful, personalized information for patients and their medical teams.
Now, a new draft Medicare/MolDX policy could remove coverage for similar testing for Ductal Carcinoma In Situ (DCIS)—Stage Zero breast cancer.
If enacted, this policy could strip Medicare patients of access to DCIS biomarker testing, such as DCISionRT—and may also influence coverage decisions for those with private insurance. Without these modern, research-backed tools, DCIS patients would be left to rely solely on traditional clinical pathology to guide surgery and treatment decisions—limiting the ability to tailor care to each individual’s unique risk.
DCIS Biomarker Testing: What It Is and Why It Matters
When someone is diagnosed with DCIS, one of the first follow-up questions is often: Do I need radiation after surgery?
Historically, if a patient is younger, radiation has been recommended after a lumpectomy to reduce the risk of recurrence. Even when clinical pathology shows a small, low-risk area of DCIS, whole or partial breast radiation is frequently included in the care plan. In some cases—based on age, tumor size, and other factors—radiation may not be recommended after a lumpectomy.
Today, there are biomarker tests that can provide a more precise answer. DCISionRT, for example, analyzes the tumor biology and predicts your ten-year risk of recurrence with and without radiation.
This level of insight empowers us to partner with our medical team to make treatment decisions that are based on our tumor biology.
Without these tools, decisions often rely solely on traditional clinical features like tumor size and grade. While helpful, those features alone cannot provide the same depth of information as tumor biology.
What the Draft Policy Says
The proposed Medicare/MolDX policy would deny coverage for tests like DCISionRT and remove coverage for Oncotype DCIS, which Medicare has covered since 2017.
Even more concerning, the policy would only allow testing if a patient agrees in advance to a specific treatment plan—before even knowing their test results.
In other words, to have coverage for a test like DCISionRT, we would have to commit to surgery without having all the information about our DCIS.
Why This Matters — and What to Tell Medicare:
- Patients deserve access to personalized risk information before deciding on radiation or surgery.
- DCIS patients must be able to avoid both overtreatment and undertreatment—biomarker tests help make that possible.
- Over 39,000 women have already used DCISionRT to guide treatment decisions, and expert panels strongly support its use in clinical care.
- Doctors and patients—not Medicare contractors—should decide how to use test results to make the best treatment plan.
- Shared decision-making is essential in quality cancer care, and this policy undermines that process.
Beyond the numbers, these decisions have real-life consequences—radiation can be exhausting, logistically challenging, and emotionally draining, especially for those who face long travel times or lack access to modern treatment facilities. I know this firsthand, because when I was diagnosed with DCIS, I faced these very decisions.
My Story: Why I’m Speaking Out
The day before my 42nd birthday in 2019, I was diagnosed with DCIS after my second annual mammogram. Overnight, I went from being a healthy mom of two teenage boys to a cancer patient faced with decisions I never wanted to make.
My team recommended a lumpectomy followed by radiation. Since my genetic testing showed no variants and my DCIS was small, I agreed to this plan. At the time, I had never heard of DCISionRT. I did request Oncotype DCIS—which was covered—but ended up making my radiation decision before the test results came back.
Radiation was one of the hardest parts of my treatment, and I was unprepared for just how difficult it would be. I went through 20 sessions. The fatigue was crushing, and the skin burns were severe enough to peel—twice. I was a healthy, active woman in my early 40s, yet radiation took more out of me than I could have imagined.
If I had known my tumor biology and it predicted I was low-risk, I might have chosen differently. I know that if I ever face another DCIS diagnosis, I will request DCISionRT—if my insurance covers it.
And I’m not alone. In DCIS support groups I lead and participate in, I see women nearly every day opting for mastectomy just to avoid radiation. Sometimes it’s fear of side effects. Sometimes it’s the lack of access to a treatment center. Either way, these are life-altering decisions—often made without the benefit of all the information that modern medicine can provide.
That’s why protecting access to DCIS biomarker testing matters so much. It’s not just about a policy—it’s about making sure every patient has the knowledge they need to make the best decision for their own health and future.
The Bigger Picture
In invasive breast cancer, Medicare and insurance companies already cover biomarker tests like Oncotype and MammaPrint. DCIS patients deserve the same access to precision medicine.
Coverage decisions made today don’t just affect Medicare patients—they often influence private insurance policies for years to come.
This isn’t just a question of cost. It’s a question of whether DCIS patients have the right to request a test that could make their treatment more effective, more tolerable, and more personalized.
If we are truly going to move forward in cancer care—and de-escalate treatments when they aren’t necessary—we must do so with data. DCISionRT offers insights into tumor biology that clinical pathology simply cannot provide.
But if we can’t access it through insurance, we are forced to make decisions without all the information.
How You Can Help
This policy is still in draft form—your voice can still shape it, so please speak up now before August 29, 2025, before it’s too late.
Here’s how you can take action today:
- Sign the Change.org petition urging Medicare to maintain coverage for DCIS biomarker testing.
- Submit public comments to MolDX/Medicare by Fri, Aug 29—share your story or explain why you believe in patient choice. Submit Public Comment
- Spread the word by sharing this blog post and the petition with your friends, family, and advocacy networks.
When you speak up, here are key points you can use:
- Patients deserve access to personalized risk information before deciding on radiation.
- Medicare should not limit tools that prevent overtreatment or undertreatment.
- Doctors and patients—not contractors—should decide how to use test results.
- This test is already helping thousands of women—don’t take that option away.
Your voice matters. Public comments help decision-makers understand how policies impact real patients and their families. By speaking out, you can help protect access to personalized, evidence-based cancer care for all DCIS patients—now and in the future.
Closing Thoughts
Navigating a breast cancer diagnosis is overwhelming. Having the right information can make all the difference in whether treatment feels like something happening to you or something you are actively shaping.
Biomarker testing for DCIS gives patients the clarity and confidence they need to partner with their medical team and make decisions based on their own tumor biology.
I urge Medicare to keep that option available—and I hope you’ll join me in speaking up for every DCIS patient’s right to personalized, evidence-based care. Together, our voices can help protect access to the tools that make informed, patient-centered treatment possible.
Jennifer Douglas
Jennifer is the author of "A Breast Cancer Journey: Living it One Step at a Time," breast cancer survivor, and patient advocate. Her book, published in 2023 by Bold Story Press, is an encouraging guide for breast cancer patients. It contains first-hand information, organized by topics, to help readers navigate the diagnosis, treatment, and recovery from breast cancer. Her writing emphasizes emotional, mental, and physical well-being along with empowered decision-making.
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