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.
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.
Authors: Mary B Daly; Robert Pilarski; Michael Berry; Saundra S Buys; Meagan Farmer; Susan Friedman; Judy E Garber; Noah D Kauff; Seema Khan; Catherine Klein; Wendy Kohlmann; Allison Kurian; Jennifer K Litton; Lisa Madlensky; Sofia D Merajver; Kenneth Offit; Tuya Pal; Gwen Reiser; Kristen Mahoney Shannon; Elizabeth Swisher; Shaveta Vinayak; Nicoleta C Voian; Jeffrey N Weitzel; Myra J Wick; Georgia L Wiesner; Mary Dwyer; Susan Darlow Journal: J Natl Compr Canc Netw Date: 2017-01 Impact factor: 11.908
Authors: Goli Samimi; Marcus Q Bernardini; Lawrence C Brody; Charlisse F Caga-Anan; Ian G Campbell; Georgia Chenevix-Trench; Fergus J Couch; Michael Dean; Joanne A de Hullu; Susan M Domchek; Ronny Drapkin; Heather Spencer Feigelson; Michael Friedlander; Mia M Gaudet; Marline G Harmsen; Karen Hurley; Paul A James; Janice S Kwon; Felicitas Lacbawan; Stephanie Lheureux; Phuong L Mai; Leah E Mechanic; Lori M Minasian; Evan R Myers; Mark E Robson; Susan J Ramus; Lisa F Rezende; Patricia A Shaw; Thomas P Slavin; Elizabeth M Swisher; Masataka Takenaka; David D Bowtell; Mark E Sherman Journal: J Clin Oncol Date: 2017-04-11 Impact factor: 44.544
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Authors: Cecelia A Bellcross; Lucy A Peipins; Frances A McCarty; Juan L Rodriguez; Nikki A Hawkins; Sharon Hensley Alford; Steven Leadbetter Journal: Genet Med Date: 2014-06-19 Impact factor: 8.822
Authors: Kristin R Muessig; Jamilyn M Zepp; Erin Keast; Elizabeth E Shuster; Ana A Reyes; Briana Arnold; Chalinya Ingphakorn; Marian J Gilmore; Tia L Kauffman; Jessica Ezzell Hunter; Sarah Knerr; Heather S Feigelson; Katrina A B Goddard Journal: Hered Cancer Clin Pract Date: 2022-02-10 Impact factor: 2.857
Authors: Fahima Dossa; Kelly Metcalfe; Rinku Sutradhar; Tari Little; Andrea Eisen; Kathy Chun; Wendy S Meschino; Lea Velsher; Jordan Lerner Ellis; Nancy N Baxter Journal: CMAJ Open Date: 2021-09-21