Large, Prospective Analysis of the Reasons Patients Do Not Pursue BRCA Genetic Testing Following Genetic Counseling

  • Sommer Hayden
  • Sarah Mange
  • Debra Duquette
  • Nancie Petrucelli
  • Victoria M. Raymond
  • on behalf of the BRCA Clinical Network Partners
Original Research

DOI: 10.1007/s10897-016-0064-5

Cite this article as:
Hayden, S., Mange, S., Duquette, D. et al. J Genet Counsel (2017). doi:10.1007/s10897-016-0064-5

Abstract

Genetic counseling (GC) and genetic testing (GT) identifies high-risk individuals who benefit from enhanced medical management. Not all individuals undergo GT following GC and understanding the reasons why can impact clinical efficiency, reduce GT costs through appropriate identification of high-risk individuals, and demonstrate the value of pre-GT GC. A collaborative project sponsored by the Michigan Department of Health and Human Services prospectively collects anonymous data on BRCA-related GC visits performed by providers in Michigan, including demographics, patient/family cancer history, GT results, and reasons for declining GT. From 2008 to 2012, 10,726 patients underwent GC; 3476 (32.4%) did not pursue GT. Primary reasons included: not the best test candidate (28.1%), not clinically indicated (23.3%), and insurance/out of pocket cost concerns (13.6%). Patient disinterest was the primary reason for declining in 17.1%. Insurance/out of pocket cost concerns were the primary reason for not testing in 13.4% of untested individuals with private insurance. Among untested individuals with breast and/or ovarian cancer, 22.5% reported insurance/out of pocket cost concerns as the primary reason for not testing and 6.6% failed to meet Medicare criteria. In a five-year time period, nearly one-third of patients who underwent BRCA GC did not pursue GT. GT was not indicated in almost half of patients. Insurance/out of pocket cost concerns continue to be barriers.

Keywords

Genetic Counseling Genetic Testing Barriers BRCA Insurance Public Health 

Copyright information

© National Society of Genetic Counselors, Inc. 2017

Authors and Affiliations

  • Sommer Hayden
    • 1
  • Sarah Mange
    • 2
  • Debra Duquette
    • 2
  • Nancie Petrucelli
    • 3
  • Victoria M. Raymond
    • 4
  • on behalf of the BRCA Clinical Network Partners
  1. 1.Saint Joseph Mercy HospitalAnn ArborUSA
  2. 2.Michigan Department of Health and Human ServicesLansingUSA
  3. 3.Barbara Ann Karmanos Cancer InstituteDetroitUSA
  4. 4.University of Michigan Health SystemAnn ArborUSA