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Promoters of BRCA testing under insurance coverage for non-metastatic breast cancer patients in Japan: a retrospective cohort study

Breast Cancer volume 30, pages 309–314 (2023)Cite this article

Abstract

Background

We investigated the barriers to and promoters of taking BRCA testing, after the start of national healthcare insurance coverage for non-metastatic breast cancer patients in Japan.

Patients and Methods

This was a multi-center, retrospective, cohort study. We included stage 0 to III breast cancer patients who were diagnosed and met the criteria for insurance coverage of BRCA testing between April 2020 and December 2021. We examined the association between BRCA testing and possible exposures: breast cancer diagnosis at 45 years or younger, triple-negative breast cancer (TNBC) diagnosis at the age of 60 or younger, two or more primary breast cancers, family history of breast cancer or ovarian cancer in the third degree of relatives, male breast cancer, medical expense limits, and parity. We used logistic regression analysis.

Results

We included 222 patients and 123 (55.4%) of them underwent the test. In univariate analysis, a family history of ovarian cancer (odds ratio (OR) 10.59; 95% CI 1.35–82.96, p = 0.025), diagnosis of breast cancer at the age of 45 or younger (OR 2.78; 95% CI 1.52–5.14, p = 0.0009), and diagnosis of TNBC at the age of 60 or younger (OR 3.95; 95% CI 1.55–10.07, p = 0.004) were associated with taking the test. After multivariate logistic regression analysis, a family history of ovarian cancer (adjusted OR 12.80; 95% CI 1.51–108.80, p = 0.0195), diagnosis of breast cancer at the age of 45 or younger (adjusted OR 4.43; 95% CI 1.98–9.90, p = 0.0003), and TNBC at the age of 60 or younger (adjusted OR 5.28; 95% CI 1.90–14.66, p = 0.0014) were consistently associated.

Conclusion

For non-metastatic breast cancer patients whose BRCA testing is covered by insurance, costs would no longer be a definite barrier. Physicians should keep in mind that a family history of ovarian cancer, breast cancer diagnosis at 45 years of age or younger and TNBC diagnosis at 60 years of age or younger are strong promoters.

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Fig. 1

Data availability statement

The data that support the findings of this study are available on request to the corresponding author.

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Acknowledgements

We thank Nobutaka Hayashi, Marina Kiso, Ai Izumi, and Megumi Syoji for their assistance and Matthew Kaste for his English editing.

Funding

Self-funding.

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Authors and Affiliations

  1. Department of Breast Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan

    Tomoe Taji, Mako Ikeda, Ai Yamaguchi & Hirofumi Suwa

  2. Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Nina Odan & Eiji Suzuki

  3. Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan

    Yuki Kataoka

  4. Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan

    Yuki Kataoka

  5. Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan

    Yuki Kataoka

  6. Department of Healthcare Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan

    Yuki Kataoka

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  1. Tomoe Taji
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  2. Nina Odan
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Correspondence to Tomoe Taji.

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Taji, T., Odan, N., Kataoka, Y. et al. Promoters of BRCA testing under insurance coverage for non-metastatic breast cancer patients in Japan: a retrospective cohort study. Breast Cancer 30, 309–314 (2023). https://doi.org/10.1007/s12282-022-01424-3

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  • DOI: https://doi.org/10.1007/s12282-022-01424-3

Keywords

  • BRCA
  • Breast cancer
  • Family history
  • Public health insurance