Unambiguous guidelines for universal germline BRCA screening for women suffering from Ovarian Cancer were made. However an analysis of the largest commercial insurance databases between 2008 to 2018 revealed that just 39% of such patients were screened.
These results were published in an JAMA Network Open research letter on the 11th of January.
The results provide “clear evidence” that germline BRCA testing (gBRCA) isn’t being used as intended, according to Stephanie Cham, MD. She is a gynecologic specialist at Brigham and Women’s Hospital in Boston.
The authors point out that about 15 percent of ovarian cancers are caused by gBRCA variants. This has important implications for treatment. It may increase the sensitivity of chemotherapy based on platinum or PARP inhibitors, as well as increase survival rates. Since 2010 guidelines have recommended universal testing.
Investigators looked at claims data from Aetna/CVS Health to determine the uptake of 3603 women diagnosed with ovarian cancer who received platinum-based chemotherapy within the first 6 month of surgery or biopsy.
The analysis showed that only 1220 women (33.9%) were examined for germline BRCA during the study time however, the rates of testing improved over the years from 14.7% in 2008 to 46.4% in 2018. The timing of the test also improved from 285 days after the first chemotherapy claim in 2008. to a median of 72.5 days in 2018.
Test rates were lower for women over 65 than for those under 50 years. They were also lower for women with Charlson Comorbidity Index scores at minimum 2 and in women receiving care at community practices (where nearly 80% of women received their care) than those who attended academic and NCI centers.
Gynecologic and medical oncologists both were similarly tested However, other physicians were tested less often perhaps due to “a lack of knowledge about guidelines,” the investigators commented.
“Future studies should examine barriers to timely testing…particularly for older women in community practices. They also said it is vital to target physicians since doctors’ recommendations are still the biggest obstacle to testing.
Study limitations included the inability to use biopsy/surgery as a diagnosis date, the lack of sociodemographic data , and the possibility that women were later tested on their treatment courses.
Agency for Healthcare Research and Quality funded the work. One of the authors was a health professional from Aetna/CVS. The senior author disclosed personal expenses incurred by GlaxoSmithKline and also grants from AstraZeneca.
JAMA Netw. Published online January 11, 2020. Full text
M. Alexander Otto, a physician assistant who holds a master’s degree in medical sciences, is an award-winning journalist who worked for a variety of major news outlets prior to joining Medscape. He is a Knight Science Journalism Fellow at the MIT. Email: [email protected].
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