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Genetic testing in privately insured women with surgically treated breast cancer

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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.

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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.

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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
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  2. Sarah Pitafi
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  3. Rachel A. Greenup
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  4. Jessica B. Long
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  5. Cary P. Gross
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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.

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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

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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

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

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