i
BRCA genetic Testing and receipt of preventive interventions among women aged 18–64 years with employer-sponsored health insurance in nonmetropolitan and metropolitan areas -- United States, 2009–2014
-
September 8, 2017
-
-
[PDF-271.84 KB]
Details:
-
Personal Author:
-
Corporate Authors:Centers for Disease Control and Prevention (U.S.)Office of Public Health Genomics. ; National Center on Birth Defects and Developmental Disabilities (Centers for Disease Control and Prevention) ; National Center for Chronic Disease Prevention and Health Promotion (U.S.)Division of Cancer Prevention and Control.
-
Description:Problem/condition: Genetic tTesting for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These tTesting results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA tTesting and receipt of preventive interventions after tTesting have not previously been examined.
Period covered: 2009-2014.
Description of systmem: Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA tTesting and receipt of preventive interventions after BRCA tTesting among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally.
Results: From 2009 to 2014, BRCA tTesting rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA tTesting rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA tTesting rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA tTesting in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years.
Interpretation: Possible explanations for the 47% decrease in the relative difference in BRCA tTesting rates over the study period include increased access to genetic services in nonmetropolitan areas and increased demand nationally as a result of publicity. The relative differences in metropolitan and nonmetropolitan BRCA tTesting rates were smaller among women at younger ages compared with older ages.
Public health action: Improved data sources and Surveillance tools are needed to gather comprehensive data on BRCA tTesting in the United States, monitor adherence to evidence-based guidelines for BRCA tTesting, and assess receipt of preventive interventions for women with BRCA mutations. Programs can build on the recent decrease in geographic disparities in receipt of BRCA tTesting while simultaneously educating the public and health care providers about U.S. Preventive Services Task Force recommendations and other clinical guidelines for BRCA tTesting and counseling.
Suggested citation for this article: Kolor K, Chen Z, Grosse SD, et al. BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18–64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas — United States, 2009–2014. MMWR Surveill Summ 2017;66(No. SS-15):1–11. DOI: http://dx.doi.org/10.15585/mmwr.ss6615a1.
-
Subjects:
-
Series:
-
Pubmed ID:28880857
-
Pubmed Central ID:PMC5879728
-
Document Type:
-
Genre:
-
Place as Subject:
-
Collection(s):
-
Main Document Checksum:
-
Download URL:
-
File Type:
