Trends in BRCA Test Utilization in an Integrated Health System, 2005–2015

• Published in: JNCI : Journal of the National Cancer Institute 2019-08, Vol.111 (8), p.795-802
• Main Authors: Knerr, Sarah, Bowles, Erin J A, Leppig, Kathleen A, Buist, Diana S M, Gao, Hongyuan, Wernli, Karen J
• Format: Article
• Language: English
• Subjects: Breast cancer; Cancer; Confidence intervals; Genetic screening; Genetics; Health care; Health risks; Ovarian cancer; Ovaries; Population studies; Regression analysis; Statistical analysis; Subgroups; Trends
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djz008

Abstract Background Genetic testing to determine BRCA status has been available for over two decades, but there are few population-based studies of test diffusion. We report 10-year trends in BRCAtesting in an integrated health-care system with long-standing access to genetic services. Methods A cohort of women aged 18 years and older was created to ascertain BRCA testing (n = 295 087). Annual testing rates between 2005 and 2015 were calculated in all women with and without incident (ie, newly diagnosed) breast and ovarian cancers and in clinically eligible subgroups by family cancer history, personal cancer history, and age at diagnosis. Secular trends were assessed using Poisson regression. Women tested early (2005–2008), midway (2009–2012), and late (2013–2015) in the study period were compared in cross-sectional analyses. Results Between 2005 and 2015, annual testing rates increased from 0.6/1000 person-years (pys) (95% confidence interval [CI] = 0.4 to 0.7/1000 pys) to 0.8/1000 pys (95% CI = 0.6 to 1.0/1000 pys) in women without incident breast or ovarian cancers. Rates decreased from 71.5/1000 pys (95% CI = 42.4 to 120.8/1000 pys) to 44.4/1000 pys (95% CI = 35.5 to 55.6/1000 pys) in women with incident diagnoses, despite improvements in provision of timely BRCA testing during this time frame. We found no evidence of secular trends in clinically eligible subgroups including women with family history indicating increased hereditary cancer risk, but no personal cancer history. At the end of the study period, 97.0% (95% CI = 96.6% to 97.3%) of these women remained untested. Conclusion Many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, underscoring challenges to primary and secondary hereditary cancer prevention.