Knerr S, et al. - Researchers analyzed trends in BRCA testing in an integrated health care system with longstanding access to genetic services, over a ten-year duration. They reported BRCA testing was not done in many eligible women even though they had insurance coverage and access to specialty genetic services. This highlights challenges to primary and secondary hereditary cancer prevention.

Methods

• BRCA testing was ascertained in a cohort of women aged 18 years and older (n = 295,087).
• Researchers computed annual testing rates between 2005 and 2015 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.
• They used Poisson regression to analyze secular trends.
• Cross-sectional analyses were carried out to compare women tested early (2005-2008), midway (2009-2012), and late (2013-2015) in the study period.

Results

• An increase in annual testing rates, from 0.6/1,000 person years (pys) (95% confidence interval [CI]: 0.4 to 0.7/1,000 pys) to 0.8/1,000 pys (95% CI: 0.6 to 1.0/1,000 pys), was reported between 2005 and 2015 for women without incident breast or ovarian cancers.
• They noted a decrease in rates, from 71.5/1,000 pys (95% CI: 42.4 to 120.8/1,000 pys) to 44.4/1,000 pys (95% CI: 35.5 to 55.6/1,000 pys) in women with incident diagnoses, despite improvements in provision of timely BRCA testing during this timeframe.
• In clinically eligible subgroups, including women with family history indicating increased hereditary cancer risk but no personal cancer history, no evidence of secular trends was found.
• Data revealed 97.0% (95% CI = 96.6% to 97.3%) of these women remained untested at the end of the study period.