Utilization of BRCA testing in older women with breast cancer and/or ovarian cancer in the state of Texas

BACKGROUND: Genetic testing for hereditary breast ovarian cancer
(HBOC) susceptibility due to BRCA1 and BRCA2 (BRCA1/2) gene
mutations became commercially available in the US in late 1996.
Medicare began cost coverage in 2000 for some women with existing
breast and/or ovarian cancer to assess treatment and family testing
options. METHODS: We used the Texas Cancer Registry-Linked Medicare Database for this population-based cross-sectional study. We identified
women aged 66 years or older with breast and/or ovarian cancer
diagnosed between 2005 and 2007 and used their Medicare claims
through 2009 to calculate the rate of testing in Texas and the proportion
of women positive for BRCA mutations. We compared our findings
to current literature. RESULTS: We identified 7,744 having at least one of the International Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM) codes identifying risk factors associated with HBOC.
Of these 7,744 women, 1,594 (20.4%) were tested, with 1,411 having
a documented risk factor and 183 with no documented risk factors.
The percentages of women with breast and ovarian cancer and positive
mutations were 0.18% and 3%, respectively. CONCLUSIONS: The study of older women with breast and/or ovarian cancer who carry the BRCA1/2 mutation is possible when using a single state’s cancer registry-linked claims administrative database. Although the prevalence of this mutation was comparable to published
estimates in a similar population, the number was small and may limit detailed study of treatment and patient outcomes. IMPACT: Studies such as ours may provide useful information for the nurses, geneticists, and genetic counselors involved in genetic counseling, and follow up of women at high risk for mutations and their families.