Skip to main content

Genetic testing in privately insured women with surgically treated breast cancer

Breast Cancer Research and Treatment volume 198, pages 177–181 (2023)Cite this article

Abstract

Purpose

Rates of BRCA1 and BRCA2 prevalence among women with breast cancer vary by age, hormone receptor status, and family history. Recommendations for genetic testing have varied between overlapping guidelines, payor coverage policies, and have evolved over time, resulting in unclear implications for adoption into routine breast cancer care.

Methods

Using a large, private insurer database, we examined rates of BRCA1/BRCA2 genetic testing in women with newly diagnosed invasive breast cancer undergoing surgery from 2015 through 2019.

Results

Testing increased among women 50 years or older from 26 to 38%, remained stable at 66% in both 2015 and 2019 in the under 50 population, and was slightly decreased in women under age 45 years.

Conclusion

Among privately insured patients with breast cancer, rates are increasing in older women, but appear persistently underused in younger women.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Data availability

The data underlying this article are held by a third party. Data for this project were accessed through Blue Cross Blue Shield Axis as part of the Blue Cross Blue Shield Alliance for Health Research. Restrictions apply to the availability of these data, which were used for the current study, and so they are not publicly available. Data are available from the authors upon reasonable request and with permission of Blue Cross Blue Shield Axis.

References

  1. Huszno J, Kołosza Z, Grzybowska E (2019) BRCA1 mutation in breast cancer patients: analysis of prognostic factors and survival. Oncol Lett 17(2):1986–1995

    CAS  Google Scholar 

  2. Peto J, Collins N, Barfoot R et al (1999) Prevalence of BRCA1 and BRCA2 gene mutations in patients with early-onset breast cancer. J Natl Cancer Inst 91(11):943–949

    Article  CAS  Google Scholar 

  3. Armstrong J, Lynch K, Virgo KS et al (2021) Utilization, timing, and outcomes of BRCA genetic testing among women with newly diagnosed breast cancer from a national commercially insured population: the ABOARD study. JCO Oncol Pract 17(2):e226–e235

    Article  Google Scholar 

  4. Petrova D, Cruz M, Sánchez MJ (2021) BRCA1/2 testing for genetic susceptibility to cancer after 25 years: a scoping review and a primer on ethical implications. Breast (Edinburgh, Scotland) 61:66–76

    Article  Google Scholar 

  5. Pujol P, Barberis M, Beer P et al (2021) Clinical practice guidelines for BRCA1 and BRCA2 genetic testing. Eur J Cancer 146:30–47

    Article  CAS  Google Scholar 

  6. Manahan ER, Kuerer HM, Sebastian M et al (2019) Consensus guidelines on genetic` testing for hereditary breast cancer from the American Society of Breast Surgeons. Ann Surg Oncol 26(10):3025–3031

    Article  Google Scholar 

  7. Tung NM, Garber JE (2018) BRCA1/2 testing: therapeutic implications for breast cancer management. Br J Cancer 119(2):141–152

    Article  CAS  Google Scholar 

  8. Robson M, Im SA, Senkus E et al (2017) Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med 377(6):523–533

    Article  CAS  Google Scholar 

  9. Grindedal EM, Heramb C, Karsrud I et al (2017) Current guidelines for BRCA testing of breast cancer patients are insufficient to detect all mutation carriers. BMC Cancer 17(1):438–438

    Article  Google Scholar 

  10. McClain MR, Palomaki GE, Nathanson KL, Haddow JE (2005) Adjusting the estimated proportion of breast cancer cases associated with BRCA1 and BRCA2 mutations: public health implications. Genet Med 7(1):28–33

    Article  CAS  Google Scholar 

  11. Beitsch PD, Whitworth PW, Hughes K et al (2019) Underdiagnosis of hereditary breast cancer: are genetic testing guidelines a tool or an obstacle? J Clin Oncol 37(6):453–460

    Article  Google Scholar 

  12. Daly MB, Pal T, Berry MP et al (2021) Genetic/familial high-risk assessment: breast, ovarian, and pancreatic, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compreh Cancer Netw 19(1):77–102

    Article  CAS  Google Scholar 

  13. Kurian AW, Ward KC, Howlader N et al (2019) Genetic testing and results in a population-based cohort of breast cancer patients and ovarian cancer patients. J Clin Oncol 37(15):1305–1315

    Article  CAS  Google Scholar 

  14. Nattinger AB, Laud PW, Bajorunaite R, Sparapani RA, Freeman JL (2004) An algorithm for the use of Medicare claims data to identify women with incident breast cancer. Health Serv Res 39(6 Pt 1):1733–1749

    Article  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Yale School of Public Health, Yale University, New Haven, CT, USA

    Michaela A. Dinan

  2. Yale College, Yale University, Harkness Office Building, 367 Cedar Street, New Haven, CT, 06520, USA

    Sarah Pitafi

  3. Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA

    Michaela A. Dinan, Jessica B. Long & Cary P. Gross

  4. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Cary P. Gross

  5. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Rachel A. Greenup

Authors
  1. Michaela A. Dinan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Pitafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachel A. Greenup
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica B. Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cary P. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Supervision of the study was conducted by Cary Gross. Data collection and analysis were conducted by Jessica Long. The first draft of the manuscript was written by Sarah Pitafi and all authors edited and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarah Pitafi.

Ethics declarations

Competing interest

Author Cary Gross has received research funding from the NCCN Foundation (Astra-Zeneca) and Genentech, as well as funding from Johnson and Johnson to help devise and implement new approaches to sharing clinical trial data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix I

HCPCS codes used to identify women who underwent breast cancer surgery.

Surgery Type

HCPCS

Mastectomy

19180, 19182, 19200, 19220, 19240, 19303, 19304, 19305, 19306, 19307

Breast Conserving Surgery

19160, 19162, 19301, 19302

Excisional Biopsy

19110, 19120, 19125, 19126

Appendix II

HCPCS codes used to detect receipt of genetic tests.

HCPCS

BRCA Testing Type

81162

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements)

81163

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis

81164

BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

81165

BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis)

81166

BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

81167

BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)

81211

Brca1, brca2 (breast cancer 1 and 2) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in brca1 (ie, exon 13 del 3.835 kb, exon 13 dup 6 kb, exon 14–20 del 26 kb, exon 22 del 510 bp, exon 8–9 del 7.1 kb)

81212

BRCA 1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants

81213

Brca1, brca2 (breast cancer 1 and 2) (e.g., hereditary breast and ovarian cancer) gene analysis; uncommon duplication/deletion variants

81214

Brca1 (breast cancer 1) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants (ie, exon 13 del 3.835 kb, exon 13 dup 6 kb, exon 14–20 del 26 kb, exon 22 del 510 bp, exon 8–9 del 7.1 kb)

81215

BRCA1 (BRCA1, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; known familial variant

81216

BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full sequence analysis

81217

BRCA2 (BRCA2, DNA repair associated) (e.g, hereditary breast and ovarian cancer) gene analysis; known familial variant

81432

Hereditary breast cancer-related disorders (e.g, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 10 genes, always including BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11, and TP53

81433

Hereditary breast cancer-related disorders (e.g., hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11

Appendix III

Sample construction timeframe diagram

figure a

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dinan, M.A., Pitafi, S., Greenup, R.A. et al. Genetic testing in privately insured women with surgically treated breast cancer. Breast Cancer Res Treat 198, 177–181 (2023). https://doi.org/10.1007/s10549-022-06829-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-022-06829-4

Keywords

  • BRCA1
  • BRCA2
  • Breast cancer
  • Genetic testing