Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer.

Area of Science:

• Oncology
• Genetics
• Health Services Research

Background:

• The OlympiA trial showed PARPi benefits for high-risk HER2- germline BRCA-mutated (gBRCAm) breast cancer.
• gBRCA testing rates are lower in early-stage HR+/HER2- breast cancer compared to TNBC.
• Understanding barriers to gBRCA testing in HR+/HER2- disease is critical.

Purpose of the Study:

• To investigate perceived barriers to germline BRCA testing in early-stage HR+/HER2- breast cancer.
• To identify discrepancies in risk assessment and testing eligibility criteria among stakeholders.

Main Methods:

• A quantitative survey was conducted with 430 stakeholders (clinicians, payers, patients).
• The survey assessed perceptions of gBRCA testing coverage, utilization, and barriers.

Main Results:

• Payers report covering gBRCA testing, but cite clinician documentation issues and overutilization as challenges.
• Utilization management controls by payers lead to reimbursement limitations and denials for healthcare professionals.
• Disagreement exists on high-risk criteria: payers use CPS+EG score, while clinicians consider genomic scores, lymph node status, and tumor characteristics.

Conclusions:

• A disconnect in risk classification between payers and healthcare professionals hinders gBRCA testing in HR+/HER2- breast cancer.
• Harmonizing risk criteria and testing eligibility is essential to increase appropriate gBRCA testing.
• Improved access to gBRCA testing can facilitate the use of PARPi in eligible early-stage breast cancer patients.