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Medically Underserved Medicare Beneficiaries Not Receiving Genetic Testing

August 22, 2018

Medically underserved Medicare beneficiaries with breast cancer or ovarian cancer rarely receive BRCA tests, which often help with health-related decision-making, according to a research letter published online in JAMA.

According to the researchers, women with ovarian cancer, who test positive for the BRCA mutations, are more likely to develop breast cancer. Further, women with breast cancer who have pathogenic BRCA mutations are more likely to develop cancer in a second breast and are also at a higher risk for developing ovarian cancer.

"Women who carry one of these mutations but don't know their mutation status are not able to take advantage of preventive or early detection interventions that we have available, so they miss out on the opportunity to reduce their risk for these cancers and potentially reduce their overall mortality," Amy Gross, PhD, lead study author and epidemiologist with the Vanderbilt Institute for Clinical and Translational Research, said in a press statement. "They are also not able to inform family members who might be affected."

For the study, 84,513 participants who were recruited at community health centers in 12 Southeastern states from 2002-2009 were identified. The researchers examined medical records and state registry data for 49,642 female participants, and determined that 2,002 were diagnosed with breast cancer, ovarian cancer or both cancers, and 718 were covered by Medicare when diagnosed. The researchers then filtered the number of female patients identified to see how many met the eligibility of Medicare coverage for BRCA1 and BRCA2 testing, which is largely based on a combination of personal and family history of cancer.

According to the findings, only 92 patients met the Medicare criteria, and of those, eight women underwent genetic testing within five years after their cancer diagnosis. Dr Gross and her colleagues noted that the medical records reviewed indicated that in 5 states— Arkansas, Louisiana, Tennessee, Virginia and West Virginia—no genetic testing was conducted.

"We were surprised at how low the test rate was although we didn't expect it to be very high," Dr Gross explained.

The research letter noted that Medicare significantly broadened the criteria for BRCA1 and BRCA2 test coverage in December 2006, but there was no large uptick seen in testing. However, during the study period, testing did increase over time. The researchers identified 14 women who qualified to receive testing between 2000 and 2004 although none of them did. Comparatively, 5% of the 40 women who qualified between 2005-2009 received testing, and 15.8% of the 38 women who qualified between 2010 and 2014 received testing.

According to the researchers, they believe that low testing rates may be due to several factors including lack of patient interest and physician recommendations. The researchers noted that based on the review of medical records, none of the physicians recorded referrals to genetic counseling.

"This testing rate is lower than what I have seen reported in terms of any other study with the same time and eligibility constraints," Dr Gross said.

Julie Gould

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