Paul Basilio, MDLinx | October 26, 2017
University of Georgia researchers have identified the reasons behind a spike in women undergoing genetic testing to evaluate their risk of breast cancer: celebrities and the US Supreme Court. The findings were recently published in Genetics in Medicine.
Women with hereditary BRCA gene mutations have a 45% to 65% risk of developing breast cancer before age 70, compared to 7% in the general population, according to the National Cancer Institute.
“BRCA testing and counseling provide important information on the risk of developing breast and ovarian cancers among women with family history of the cancers,” said Zhuo “Adam” Chen, PhD, an associate professor of health policy and management at UGA’s College of Public Health, and lead author on the study. “Appropriate use of BRCA testing would lead to reduction in avoidable cancer mortalities and morbidities.”
Dr. Chen and his colleagues wanted to understand the trends in utilization and costs associated with BRCA. They conducted an analysis of testing rates, provider payments, and out-of-pocket costs for patients from 2003 to 2014. The findings were compared to reported revenue from Myriad Genetics, the only provider of the test until 2013.
Results showed that BRCA testing increased 80-fold during those 11 years, with a large spike in 2013. It was in that year that actress Angelina Jolie published an op-ed in the New York Times promoting BRCA gene testing, and the Supreme Court struck down the patent on BRCA gene testing.
“This could provide insights on the impact of the policy changes and the media coverage of celebrity endorsement,” said Dr. Chen.
Current US Preventive Services Task Force guidelines recommend BRCA testing for women who are at high risk. Under the Affordable Care Act, most private health plans are required to provide in-network coverage to women with a family history of breast and ovarian cancer without cost-sharing for BRCA genetic counseling as a preventive service.
The easy conclusion is that the spike was caused by the whirlwind of media coverage surrounding Jolie’s decision to have a double mastectomy following a positive BRCA test, but Dr. Chen says the available data cannot point to which event had a greater impact.
“Jolie’s op-ed, the Supreme Court decision on BRCA gene, and the USPSTF recommendation occurred in a very compact timeline,” he explained.
Dr. Chen’s team has analyzed the difference in the use of BRCA testing among women at elevated risk versus women at low risk, but any significant differences were hard to tease out from available data.
“In a companion study, we did examine whether women had follow-up surgical procedures and found an urban and rural disparity in the follow-up rates,” he said. “Women residing in urban areas consistently had a higher rates of follow-up surgical procedures than those in rural areas, though the gap is narrowing.”
As genetic testing becomes more accessible, Dr. Chen sees potential for individuals to make more informed decisions about their health.
“We live in a fortunate time where technology advances have greatly improved the quality of human life,” he said.
To read more about this study, click here.