Research article summary (published 29 Sep 2009):

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

Full Abstract

BACKGROUND: Strategies to reduce the risk of developing breast and ovarian cancer in carriers of deleterious BRCA 1 and 2 mutations are readily available. However, many people who are at high risk of having these genetic mutations are reluctant to obtain the test. We sought to identify factors associated with choice of testing. METHODS: We performed a retrospective cohort review of high-risk patients referred to a multidisciplinary breast health center for BRCA testing between January 2001 and March 2008. Demographic variables were compared by using logistic regression between those who completed genetic testing and those who did not. RESULTS: A total of 213 patients were referred for BRCA testing. The mean age was 49.2 years (range, 16-84 y). Five patients were male. The majority of individuals (63.4%) were white, 15% were Hispanic, 6.6% were black, and 4.7% were Asian. Insurance coverage for testing was available in 91.1% of patients, of whom 49.2% had private insurance, 26.7% had managed care insurance, and 24.1% had government-sponsored insurance. A total of 111 patients (52.1%) underwent testing. On multivariate analysis, patients were significantly more likely to complete testing if they had a personal history of breast cancer (73.0% of tested patients) (P = .005) and had at least some college education (61.3%) (P = .03). There were no statistically significant differences in tested versus untested groups by age, race, language, family history, parity, marital status, religion, socioeconomic status, or insurance status. Of patients whose insurance plans offered coverage for genetic testing, 51.4% underwent testing and 48.6% did not (P = not significant [NS]). Of those who had no insurance coverage for testing, 41.2% underwent testing and 58.9% did not (P = NS). CONCLUSIONS: Our data show that half of those patients at risk for carrying a BRCA mutation do not undergo testing. Insurance coverage for genetic testing does not influence the decision to test. Developing counseling instruments that explain the benefits of testing to unaffected high-risk individuals or targeted to those with a high school level education may be a strategy to improve testing rates.

Author information

Author/s: Olaya, Windy (W); Esquivel, Pamela (P); Wong, Jan H (JH); Morgan, John W (JW); Freeberg, Adam (A); Roy-Chowdhury, Sharmila (S); Lum, Sharon S (SS);

Affiliation: Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, 11175 Campus St., CP 21111, Loma Linda, CA, USA.

Journal and publication information

Publication Type: Journal Article

Journal: American journal of surgery (Am J Surg), published in United States. (Language: eng)

Reference: 2009-Oct; vol 198 (issue 4) : pp 562-5

Dates: Created 2009/10/05; Completed 2009/10/19;

PMID: 19800469, status: MEDLINE (last retrieval date: 10/19/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Adult Aged Aged, 80 and over Breast Neoplasms - genetics Breast Neoplasms, Male - genetics Cohort Studies Decision Making Female Genes, BRCA1 Genes, BRCA2

Genes, BRCA2 Genetic Screening Health Services Accessibility Healthcare Disparities Humans Insurance Coverage Male Middle Aged Patient Acceptance of Health Care Retrospective Studies Young Adult

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