BACKGROUND AND PURPOSE:

• BRCA testing utilization increased between the mid 2000s and mid 2010s, in line with 2005 USPSTF recommendations that called for genetic testing of those with a family history
• Testing recommendations have expanded in recent years, with new USPSTF recommendations in 2019 recommending testing for a wider population
  • The recent impact of new testing guidelines, as well as new testing technologies, on BRCA testing utilization has not been studied
• Shi et al. (Genetics in Medicine, 2025) evaluated the utilization of BRCA testing using US MarketScan claims data from 2013 to 2022 for women and men aged 18 to 64 years

METHODS:

• Population-based study
  • Data from US MarketScan Commercial Database
• Population
  • 18 to 64 years
  • Continuously enrolled in capitated or noncapitated plans for ≥1 year
• Exposures
  • Year
  • Sex
  • Indications for testing
• Study design
  • Average annual growth rates of utilization were estimated by regressing the natural logarithm of utilization rates on the calendar year
• Primary outcomes
  • Annual utilization rates of BRCA testing overall and by BRCA test type
  • Median expenditures per enrollee
  • Percentage of 0 out-of-pocket expenditures

RESULTS:

• Annual BRCA testing utilization among women and men increased every year between 2014 and 2019
  • Women
    • 2014 to 2015: 10.2% per year
    • 2016 to 2019: 10.0% per year
  • Men
    • 2014 to 2015: 44.5%
    • 2016 to 2019: 44.8%
• Testing decreased in 2020
  • Women: 34.4%
  • Men: 44.8%
• Annual testing rates rebounded each year during 2021 to 2022, though they remained below pre-pandemic levels
  • Women: 8.5%
  • Men: 22.3%
• Median expenditures for comprehensive BRCA testing per enrollee decreased from 2013 to 2022: 68%
  • Most of these enrollees had 0 out-of-pocket expenditures
• Most BRCA testing was performed on individuals
  • With family cancer history: Breast | Ovarian | Prostate
  • Among women 18 to 50 years

CONCLUSION:

• The BRCA testing rate has modestly increased annually despite more expansive guidelines and decreasing out of pocket costs
• The authors state

These findings have implications for the need to educate health providers, including primary care providers and public health programs, as well as health insurers, about current BRCA testing eligibility criteria, recent reductions in costs, and the benefits of testing to inform interventions for cancer prevention and earlier detection for their patients

Learn More – Primary Sources:

BRCA genetic testing utilization and expenditures among privately insured adults in the United States, 2013 to 2022