Germline BRCA testing underutilized in ovarian cancer
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Even among insured patients, germline BRCA testing is underutilized in women with newly diagnosed ovarian cancer, according to a study presented at the virtual ASCO Annual Meeting.
Stephanie Cham, MD, from Brigham and Women’s Hospital, and colleagues used logistic regression to assess patient, clinician and practice-level characteristics associated with germline BRCA testing and found that although numbers have shown improvement over time, more strategies to increase the number of patients being tested should be explored.
“Germline BRCA testing has important prognostic therapeutic and familial implications for ovarian cancer,” Cham said during a poster presentation. “Since 2010, national guidelines have recommended universal germline BRCA testing, but few data are available about the rates and timeliness of testing or factors associated with testing. The purpose of the study was to determine the rates and timing of germline BRCA testing in [patients with] ovarian cancer.”
The researchers analyzed 3,603 commercially insured women aged 18 years and older who received chemotherapy or surgery between 2008 and 2018 for ovarian, fallopian tube or peritoneal cancers. Cham reported that the overall germline BRCA testing rate among the women assessed was 33.9%, increasing from 14.7% in 2008 to 46.4% in 2018.
Older women appeared less likely to undergo testing, with an adjusted 20.8-percentage point difference between those aged older than 65 vs. younger than 50 (95% CI, –25.8 to –16.4). Testing rates were also lower in women with more comorbidities, with an adjusted difference of 4.6 percentage points for patients with a Charlson score of at least 2 vs. 0 (95% CI, –8.9 to –0.2).
Compared with community practices, testing occurred more frequently at academic and NCI-designated cancer centers, with an adjusted difference of 4.5 percentage points between community vs. NCI centers (95% CI, –8.8 to –0.2). Testing rates did not differ significantly between medical and gynecologic oncologists, according to the data.
Cham reported that rates of germline BRCA testing have increased over time, peaking at 54.1% in 2016 before declining slightly in 2018. Additionally, the days from diagnosis to testing decreased from 280 days in 2008 to 72.5 days in 2018 — a difference that coincided with the 2010 NCCN guidelines’ recommendation on germline BRCA testing and the 2014 FDA approval of the first poly(ADP-ribose) polymerase, or PARP, inhibitor for recurrent disease in patients with germline BRCA mutations.
“While the rates of germline BRCA testing in patients with ovarian cancer have improved over time, germline BRCA testing remains underutilized in this large, commercially insured cohort,” Cham said. “Future studies should identify scalable strategies for increasing testing, particularly for older women with ovarian cancer treated in community practices.”
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Cham S, et al. Abstract 5539. Presented at: 2021 ASCO Annual Meeting; June 4-8, 2021 (virtual meeting).
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