When Alexandra Duffin noticed some inflammation on her left breast, she was understandably concerned.
After she also found a lump, she decided to go to her GP and get it checked out – she did have a family history of breast cancer after all.
During what was a highly stressful and anxiety-filled period, the one thing the 29-year-old did not expect was to fork out $645 for a breast MRI.
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But there is a specific set of criteria that someone must meet in order to receive a Medicare rebate for a breast MRI, none of which applied to Duffin.
Upon learning this, the online content creator took to social media, creating a discourse among her followers, with many sharing similar experiences.
With an estimated an 20,428 women diagnosed with breast cancer in 2022, Duffin said something needed to change.
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Noticing something wasn’t right
Duffin, from Melbourne, initially didn’t think anything of the red mark she found on her left breast about two months ago.
However, over the following week it got bigger, growing to about the size of an orange.
Becoming increasingly concerned, she recruited the help of her mother, asking her to check for any lumps.
To Duffin’s alarm, her mother found one.
“The lump was (located) … up the top,” she told 7NEWS.com.au.
“I was confused, and I was like that’s weird because the inflammation is on the bottom (of the breast).”
Alexandra Duffin underwent an ultrasound and an MRI after finding some inflammation and a lump in her left breast. Credit: Supplied/ Instagram
The 29-year-old quickly booked in to see her GP, who referred her for an ultrasound.
Fast forward two months, Duffin was in Sydney visiting her partner when she received a call from her GP, who informed her they’d found a cyst in her breast.
Due to her family history, Duffin was told it would be best to get a breast MRI, which she did on August 15.
Duffin’s grandmother had previously been diagnosed with the disease, as well as her great-auntie and great uncle.
“I was quite anxious about it,” Duffin said of the MRI.
The ‘ridiculous’ $645 bill
While Duffin was informed the MRI may cost a couple of hundred dollars, she was shocked when the radiology clinic billed her $645.
“(I asked them) what if I have a family history? Like my mum read up on all the family history,” Duffin said.
“I was like ‘this is ridiculous’, how is it $645 just to get an MRI done just because I needed it and I wanted to make sure what kind of cyst it was.
“What if I didn’t have a job? What if I didn’t have money to afford it?”
According to Breast Cancer Network Australia, patients can get a Medicare rebate if they meet the eligibility criteria for being a high risk of developing breast cancer or if they have a referral from a specialist.
To be identified as a person with a high risk of developing the disease, a series of very specific criteria has to be met including:
Genetic testing that shows the patient has a high risk breast cancer gene mutation;A personal history of breast cancer before the age of 50; andA first or second-degree relative who was diagnosed with breast cancer at 45-years-old or under.
Duffin did not meet any of the criteria.
Her grandmother, who qualifies as a second-degree relative, was diagnosed at 57 years old. She passed away eight years later.
“It’s disgusting. Why do we have to pay so much money and go through these steps just to get that done?,” Duffin said.
“It needs to be changed.”
Patients can get a Medicare rebate if they meet the eligibility criteria for being a high risk of developing breast cancer or if they have a referral from a specialist. Credit: AAPIMAGE
Australian radiology body calls for change
The Royal Australian and New Zealand College of Radiologists (RANZCR) president professor Sanjay Jeganathan told 7NEWS.com.au that he supports greater access to breast MRIs.
He said the cost of diagnostic imaging had not kept up with rising inflation and cost-of-living pressures, which often meant those extra costs were passed on to patients.
“The continually increasing costs of items such as staff salaries, rent, and equipment costs means that fees need to increase, making it difficult for patients,” Jeganathan said.
“RANZCR will closely look at how the government could step in to better fund radiology services.”
Jeganathan also said any medical practitioner, not just a specialist, should be able to refer a patient for an MRI in order to get a rebate.
“This is a duplication of services. To see the specialist, the patient would be out of pocket by a few hundred dollars, as well as having a long waiting time for a specialist appointment,” he said.
“If a GP referred for a scan, the patient would only have an out-of-pocket cost of maybe $30 or $40.”
A spokesperson from the department of health and aged care said Medicare eligibility criteria are based on the recommendations of the Medical Services Advisory Committee (MSAC).
“MSAC is an independent, expert committee that advises the Australian Government on the evidence relating to the safety, efficacy and cost-effectiveness of new medical technologies and procedures, as well as determining the clinical parameters for each Medicare Benefits Schedule (MBS) item, including which patients are most likely to benefit from the service,” the spokesperson said.
“The MSAC process helps ensure that Australians have access to medical services that have been shown to be safe and clinically effective, as well as representing value-for-money for taxpayers who fund the MBS rebates.”
Alexandra Duffin made two TikToks talking about her experience. Credit: TikTok
On November 1, 2022, the patient eligibility for breast MRI’s was expanded.
“This followed a further recommendation from MSAC on this service,” the spokesperson said.
“Should there be further clinical evidence to support a change to this MBS listing, it can be submitted to MSAC for its consideration and advice.”
The spokesperson also said there were other imaging options available to patients with cysts that are subsided, such as a biopsy or a mammography.
Thankfully, Duffin’s MRI came back all clear for cancer.
She learned that she is prone to lumps in her breast tissue, meaning she now has to get regular testing done.
Duffin will undergo genetic testing for the BRCA1 and BRCA2 breast cancer genes, which could help her receive more of a rebate in the future.
The 29-year-old said it still should be easier for people to get tested for breast cancer without having to jump through the hoops of genetic testing just to get some money back.
“When (I) went to the doctor, he said ‘OK, so you need to email this to me, and then I’ll email them, and then you get the testing done’,” Duffin said.
“It’s really stressful, it shouldn’t be like this.
“Breast cancer is quite serious, and it’s very, very, very well known. For women to not be able to get tested easy, it’s really hard.”
Duffin’s TikToks detailing her experience have been seen over 50,000 times.
She said sharing what happened to her following was a “no brainer”.
“I go on (TikTok to) … just show you know, random things, it could be me in general … I show my personality,” the online creator said.
“So I was like, if I’m going to share all of that, I’m definitely going to share this.”
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