Approximately 10% of breast and ovarian cancers in women and 15% of breast cancers in males are associated with germline mutations, most commonly mutations in the BRCA 1 and 2 genes. Patients with these hereditary cancers are at heightened risk for other BRCA-associated tumors, and as such, risk assessment and genetic testing in high-risk scenarios is recommended.
Recommendations since 2009–2010 suggest that all women with ovarian cancer and men with breast cancer should undergo BRCA testing. Among women with breast cancer, testing recommendations vary by age at diagnosis and personal and family history. We examined the performance of BRCA testing in patients with newly diagnosed breast and ovarian cancer.
Materials and Methods
The MarketScan database was used to identify patients with newly diagnosed breast or ovarian cancer from July 2009 to June 2013. We selected subjects who underwent primary cancer–directed surgery within 6 months of the first recorded code for the cancer of interest.
Testing for BRCA 1 and 2 was identified using Current Procedural Terminology and Healthcare Common Procedure Coding System codes. A patient was considered to have undergone BRCA testing if a test for either gene was ordered within 6 months before or after the date of diagnosis. Trends in testing over time were examined in the entire cohort and in the subset of younger patients (≤ 50 years of age).
Results
We identified 116,793 women with breast cancer, 874 males with breast cancer, and 11,966 patients with ovarian cancer. BRCA testing was performed in 22.9%, 31.0%, and 17.4%, respectively. For each tumor, BRCA testing increased over time. For women with breast cancer, BRCA testing was performed in 20.0% in 2009 and rose to 26.5% by 2013 ( P < .001) ( Figure A). Among men with breast cancer, BRCA testing rose from 20.9% in 2009 to 41.6% in 2013 ( P < .001). In women with ovarian cancer, testing was 12.1% in 2009, rose to 21.0% in 2012, and then declined to 19.5% in 2013 ( P < .001).
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