BRCA1/2 testing among young women with breast cancer in Massachusetts, 2010–2013: An observational study using state cancer registry and All-Payer claims data

Abstract

Background: Testing for BRCA1/2 pathogenic variants is recommended for women aged ≤45 years with breast cancer. Some studies have found racial/ethnic and socioeconomic disparities in testing. We linked Massachusetts' All-Payer Claims Database with Massachusetts Cancer Registry data to assess factors associated with BRCA1/2 testing among young women with breast cancer in Massachusetts, a state with high levels of access to care and equitable insurance coverage of breast cancer gene (BRCA) testing. Methods: We identified breast cancer diagnoses in the Massachusetts Cancer Registry from 2010 to 2013 and linked registry data with Massachusetts All-Payer Claims Data from 2010 to 2014 among women aged ≤45 years with private insurance or Medicaid. We used multivariable logistic regression to examine factors associated with BRCA1/2 testing within 6 months of diagnosis. Results: The study population included 2424 women; 80.3% were identified as non-Hispanic White, 6.4% non-Hispanic Black, and 6.3% Hispanic. Overall, 54.9% received BRCA1/2 testing within 6 months of breast cancer diagnosis. In adjusted analyses, non-Hispanic Black women had less than half the odds of testing compared with non-Hispanic White women (adjusted odds ratio [OR] = 0.45, 95% CI = 0.31, 0.64). Medicaid-insured women had half the odds of testing compared with privately-insured women (OR = 0.51, 95% CI = 0.41, 0.63). Living in lower-income areas was also associated with lower odds of testing. Having an academically-affiliated oncology clinician was not associated with testing. Conclusion: Socioeconomic and racial/ethnic disparities exist in BRCA1/2 testing among women with breast cancer in Massachusetts, despite equitable insurance coverage of testing. Further research should examine whether disparities have persisted with growing testing awareness and availability over time.