Download Colorectal Cancer Panel

[DATE]
Patient: [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]
Insurance Company: [INSURANCE_COMPANY_NAME]
Subscriber Name: [POLICY_HOLDER_NAME]
Policy #: [POLICY_NUMBER]
Dear Claims Specialist,
I am writing this letter on behalf of my patient [PATIENT_FIRST_NAME]
[PATIENT_LAST_NAME] to request coverage for the OncoGeneDx Colorectal Cancer panel, a
genetic test offered through GeneDx, a high complexity CLIA certified laboratory located in
Gaithersburg, Maryland.
Personal and Family History:
[PATIENT_FIRST_NAME] is a [PATIENT_AGE] year-old [PATIENT_GENDER] suspected
to have hereditary colorectal cancer. [MR./MS.] [PATIENT_LAST_NAME] was diagnosed with
XX cancer at age XX years. [HIS_HER] family history is remarkable for (discuss family history).
[MR./MS.] [PATIENT_LAST_NAME]’s (personal and/or family) history is suggestive of a
diagnosis of hereditary colorectal cancer. However, the only way to thoroughly assess this patient’s
future cancer risks is to perform genetic testing. The results of this genetic test will have a
direct impact on this patient’s treatment and management.
Test Information and Impact of Results on Medical Management:
As you are aware, multiple genes are associated with hereditary colorectal cancer. The
OncoGeneDx Colorectal Cancer panel includes analysis of many highly penetrant genes affecting
colorectal cancer risk. Panel testing utilizes next generation sequencing technology, which allows
for analysis of multiple genes simultaneously. This is far more cost effective and timely than
stepwise genetic testing (for example, ordering testing of one or two genes followed by additional
genetic testing, if negative).
An additional benefit of the OncoGeneDx Colorectal Cancer panel is the ability to test for
multiple hereditary cancer syndromes at once. Many hereditary colorectal cancer pedigrees display
significant phenotypic overlap with those of other hereditary cancer syndromes. For example,
multiple cases of gastric cancer may be present in a family with Lynch syndrome (MLH1, MSH2,
MSH6, PMS2 and EPCAM genes) or with hereditary diffuse gastric cancer caused by mutations in
the CDH1 gene. A hereditary cancer syndrome diagnosis cannot always be established based upon
the pedigree analysis alone. The OncoGeneDx Colorectal Cancer panel tests for genes associated
with multiple hereditary cancer syndromes that may have similar presentations, including Lynch
syndrome, Familial Adenomatous Polyposis (FAP) and Attenuated FAP, MUTYH-Associated
Polyposis (MAP) syndrome, Juvenile Polyposis syndrome (JPS) and others. While each of these
syndromes is associated with significantly increased risks of colorectal cancer, each syndrome has
gene-specific and site-specific cancer risks for which National Comprehensive Cancer Network
(NCCN) management recommendations differ1. These may include increased cancer surveillance
and options for prophylactic surgeries and chemoprevention. Thus, it is essential that an
accurate diagnosis is established for this patient in order to determine [HIS_HER]
appropriate medical management.
Conclusion:
Knowledge of this patient's genetic information is important for me to more accurately assess
[HIS_HER] cancer risks and will guide my recommendations for [HIS_HER] care. I am specifying
GeneDx because this laboratory has highly sensitive, rapid and cost-effective genetic testing for
hereditary colorectal cancer.
Thank you for your review and consideration. I hope you will support this request for genetic
testing coverage for [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]. If you have
questions, or if I can be of further assistance, please do not hesitate to call me at
[PHYSICIAN_PHONE_NUMBER].
Sincerely,
[PHYSICIAN_FIRST_NAME] [PHYSICIAN_LAST_NAME], MD
cc: [PATIENT_FIRST_NAME] [PATIENT_LAST_NAME]
1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/Familial
High-Risk Assessment: Colorectal. Version 2.2014. www.nccn.org.