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William J. Gradishar, MD, FACP, FASCO


BRCA Testing in Patients With Breast Cancer: Does Type of Insurance Matter?

By: Jenna Carter, PhD
Posted: Tuesday, November 14, 2023

In a presentation at the 2023 American Society of Clinical Oncology (ASCO) Quality Care Symposium (Abstract 148), investigators reported on the rates of BRCA testing in patients with breast cancer who had Medicaid vs commercial insurance. Elena B. Elkin, PhD, of Columbia University Mailman School of Public Health, New York, and colleagues examined whether BRCA testing was received within 6 months of the first breast cancer–related claim. Their findings revealed that patients with Medicaid were more likely to receive BRCA testing than their counterparts with commercial insurance.

“Prior studies have found substantial underuse of BRCA testing in breast cancer patients and disparities by socioeconomic factors,” stated Dr. Elkin and colleagues.

The Clarivate Real-World Data Product was employed in this study to identify adults (between the ages of 18 and 64) with commercial insurance (41,259) or Medicaid (147,050). Identified patients had claims for breast cancer diagnosis and treatment between 2016 and 2021. Receipt of a BRCA test within 6 months of the first breast cancer claim was established as the primary study outcome, and a multivariate logistic regression was used to estimate the impact of insurance type on BRCA test receipt. Analyses were controlled for demographic and health characteristics.

Overall findings revealed that compared with those who had commercial insurance, Medicaid beneficiaries were younger and more likely to have metastatic disease and comorbid conditions. Findings also revealed that patients with Medicaid coverage were more likely to receive a BRCA test within 6 months of an initial breast cancer–related claim than their commercial coverage counterparts (16.8% vs 11.7%), with an adjusted odds ratio of 1.41 (95% confidence interval = 1.36–1.46). Additionally, receipt of a BRCA test was more likely to occur in younger male patients with metastatic disease or greater comorbidity. Based on these findings, the presenters concluded that expanding testing in both groups is necessary to facilitate access to effective therapies associated with germline BRCA1/2 mutations.

Disclosure: Dr. Elkin has received research funding from Pfizer. For full disclosures of the other study authors, visit

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