BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines
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Guideline-concordant cancer care is a priority within the Department of Veterans Affairs (VA). In 2009, the VA expanded its capacity to treat breast cancer patients within VA medical centers (VAMCs). We sought to determine whether male and female Veterans diagnosed with breast cancer received BRCA testing as recommended by the National Comprehensive Cancer Network (NCCN) guidelines on Genetic/Familial High-Risk Assessment in Breast and Ovarian Cancer (v. 1.2010–1.2012). Using the 2011–2012 VA Central Cancer Registry and BRCA test orders from Myriad Genetics, we conducted a retrospective study. The outcome variable was a recommendation for genetic counseling or BRCA testing, determined by chart review. Independent variables expected to predict testing included region, site of care, and patient characteristics. We performed descriptive analysis of all patients and conducted multivariable logistic regression on patients who sought care at VAMCs that offered BRCA testing. Of the 462 Veterans who met NCCN testing criteria, 126 (27 %) received guideline-concordant care, either a referral for counseling or actual testing. No BRCA testing was recommended in 49 (50 %) VAMCs that provide cancer treatment. Surprisingly, patients with second primary breast cancer were less likely to be referred/tested (OR 0.39; CI 0.17, 0.89; p = 0.025). For patients under age 51, a yearly increase in age decreased likelihood of referral or testing (OR 0.85; CI 0.76, 0.94; p < 0.001). There were no differences in testing by race. In conclusion, there was significant underutilization and lack of access to BRCA testing for Veterans diagnosed with breast cancer. Our research suggests the need for clinical decision support tools to facilitate delivery of guideline-concordant cancer care and improve Veteran access to BRCA testing.
KeywordsGenetic testing Breast cancer BRCA Clinical guidelines
This research was supported using resources and facilities at the VA Salt Lake City Health Care System with funding from the Department of Veterans Affairs Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457 (to S. L. DuVall). B. Berse and J. A. Lynch are funded by the National Cancer Institute through an Interagency Agreement. IAA 14001-0000-01001.
Compliance with ethical standards
Conflict of interest
J. A. Lynch and B. Berse completed a prostate cancer study that involved research collaboration with Myriad Genetics. Other authors declare no conflict of interest.
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