Utilization, Timing, and Outcomes of BRCA Genetic Testing Among Women With Newly Diagnosed Breast Cancer From a National Commercially Insured Population: The ABOARD Study

• Type of Material: Article
• Authors: Joanne Armstrong, Aetna Inc.; Kristian Lynch, University of South Florida, Tampa; Katherine Virgo, Emory University; Marc D Schwartz, Georgetown Lombardi Comprehensive Cancer Center; Sue Friedman, Facing Our Risk of Cancer Empowered, Inc (FORCE); Marleah Dean, University of South Florida, Tampa; James E Andrews, University of South Florida, Tampa; Elizabeth Bourquardez Clark, University of South Florida, Tampa; Joanna Clasen, University of South Florida, Tampa; Jessica Conaty, University of South Florida, Tampa; Olivia Parrillo, University of South Florida, Tampa; Rebecca Sutphen, University of South Florida, Tampa
• Language: English
• Date: 2021-02-01
• Publisher: American Society of Clinical Oncology
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by American Society of Clinical Oncology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1200/OP.20.00571
• Title of Journal or Parent Work: JCO oncology practice
• Volume: 17
• Issue: 2
• Start Page: e226
• End Page: e235
• Grant/Funding Information: This research was supported with funds received through the National Institute of Health’s National Cancer Institute via grant number: R01CA172743.
• Keywords: Genes, BRCA2; Mastectomy; Humans; Genes, BRCA1; Genetic Testing; Breast Neoplasms; Female
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

Abstract

PURPOSE: To evaluate timing and outcomes of BRCA testing and definitive surgical treatment among patients with newly diagnosed breast cancer. METHODS: Patient-reported (n = 1,381) and deidentified health-plan (n = 2,369) data were analyzed from a consecutive national series of 3,750 women whose healthcare providers ordered BRCA testing between March 2014 and June 2015, within 1 year following breast cancer diagnosis. RESULTS: Among 1,209 respondents, 54.4% received the genetic test results presurgery, 23.2% tested presurgery but received the results postsurgery, and 22.3% tested postsurgery. Patients aware of mutation-positive results presurgery were more likely to choose bilateral mastectomy (BLM) (n = 32/37) compared with patients who learned of positive results postsurgery (n = 14/32), (odds ratio [OR] = 8.23, 95% CI = 2.55 to 26.59, P < .001). When compared with women tested postsurgery, only women unaware of negative results presurgery had higher BLM rates (adjusted OR = 1.70, 95% CI = 1.07 to 2.69, P = .02). Among women > 50 tested presurgery, those unaware of negative results presurgery were more likely to choose BLM (n = 28/81) compared with those aware of negative results (n = 32/168) (OR = 2.25, 95% CI = 1.23 to 4.08, negative results awareness × age interaction, and P = .007). CONCLUSION: Nearly half of participants did not receive BRCA results presurgery, which limited their ability to make fully informed surgical treatment decisions. This may represent suboptimal care for unaware mutation-positive patients compared with those who were aware presurgery. Women > 50 who test negative are significantly less likely to choose BLM, a costly surgery that does not confer survival advantage, if they are aware of negative results presurgery. These results have important implications for quality of care and costs in the US health system.