Disparities in BRCA testing: when insurance coverage is not a barrier

Area of Science:

• Genetics
• Oncology
• Preventive Medicine

Background:

• BRCA 1 and 2 mutations significantly increase breast and ovarian cancer risk.
• Effective risk-reduction strategies exist for mutation carriers.
• Many high-risk individuals are reluctant to undergo genetic testing for BRCA mutations.

Purpose of the Study:

• To identify factors influencing the decision-making process for BRCA genetic testing among high-risk individuals.
• To understand the barriers and facilitators to BRCA testing uptake.

Main Methods:

• Retrospective cohort review of 213 high-risk patients referred for BRCA testing (2001-2008).
• Logistic regression analysis to compare demographic and clinical variables between patients who completed testing and those who did not.
• Assessment of factors including personal history of breast cancer, education level, and insurance status.

Main Results:

• 52.1% of referred patients underwent BRCA testing.
• A personal history of breast cancer (OR=3.0, P=.005) and having some college education (OR=1.9, P=.03) were significantly associated with higher testing completion rates.
• Insurance coverage for genetic testing did not significantly influence the decision to test.

Conclusions:

• Approximately half of individuals at high risk for BRCA mutations do not pursue genetic testing.
• Insurance coverage is not a determining factor in BRCA testing decisions.
• Targeted educational counseling, particularly for unaffected individuals and those with lower educational attainment, may enhance testing rates.