Recent Patterns in Genetic Testing for Breast and Ovarian Cancer Risk in the U.S.

Abstract

Mutations in BRCA genes are strongly associated with increased risk of breast and ovarian cancer, and it is recommended that women at high risk for these mutations be referred for genetic counseling and testing. The Affordable Care Act (ACA) provision implemented in 2010 eliminated cost sharing for BRCA genetic testing for privately insured women with family history of BRCA-related cancers. Using a nationally representative sample from the National Health Interview Survey, this study examined trends in genetic testing for breast and ovarian cancer risk from 2005 to 2015 among women by family history and insurance status. To assess the impact of the ACA provision, a difference-in-differences strategy was used to compare changes in genetic testing after ACA implementation between women with a family history of breast or ovarian cancer and those with a family history of other cancers, stratified by insurance type. Analyses were conducted in 2016. Genetic testing for breast and ovarian cancer risk increased among women with private or public insurance, but not among uninsured women. Among privately insured women, those with family history of breast or ovarian cancer experienced a net increase of 2.9 percentage points (p=0.001) over those with a family history of other cancers, but no significant difference was observed among women with public insurance, suggesting a positive effect of the ACA provision. This study underscores the continued need to improve access to care for all populations. Future work should monitor the impact of policy on genetic testing among the high-risk population.