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09.11.2018 | Epidemiology

Concordance with BRCA1/2 testing guidelines among women in The Health of Women (HOW) Study®

Breast Cancer Research and Treatment
Michelle I. Silver, William Klein, Goli Samimi, Lori Minasian, Jennifer Loud, Megan C. Roberts
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10549-018-5035-0) contains supplementary material, which is available to authorized users.
This research has been presented in part at the San Antonio Breast Cancer Symposium 2017 and the American Society for Preventive Oncology Annual Meeting 2018.



To evaluate factors associated with compliance to the National Comprehensive Cancer Network (NCCN) guidelines for BRCA1/2 testing and identify groups who are at risk of under- and over-use of BRCA1/2 testing.


Data included 20,758 women from Dr. Susan Love Research Foundation’s The Health of Women (HOW) Study®. Multinomial logistic regression was used to examine the association of socioeconomic and demographic characteristics with whether the woman was over-, under-, or appropriately tested for BRCA1/2 mutations, per 2015 NCCN guidelines.


3894 women (18.8%) reported BRCA1/2 testing. 5628 (27.1%) women who met NCCN criteria for testing were not tested. Among women with a history of breast cancer, those without health insurance were more likely to be under-tested (OR 2.04, 95% CI 1.15–3.60) than those with managed care insurance, and higher education was associated with a lower likelihood of under-testing (Graduate/professional degree OR 0.71, 95% CI 0.55–0.91).


Almost 30% of women were under-tested, indicating that many high-risk women who may benefit from genetic testing are currently being missed. Without appropriate testing, providers are unable to tailor screening recommendations to those carrying mutations who are at highest risk. Patient and healthcare provider education and outreach targeted to low-income and under-served populations may assist in reducing under-testing.

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