Journal article
BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines
Familial cancer, Vol.16(1), pp.41-49
01/2017
DOI: 10.1007/s10689-016-9921-5
PMID: 27589855
Abstract
Guideline-concordant cancer care is a priority within the Department of Veterans Affairs (VA). In 2009, the VA expanded its capacity to treat breast cancer patients within VA medical centers (VAMCs). We sought to determine whether male and female Veterans diagnosed with breast cancer received BRCA testing as recommended by the National Comprehensive Cancer Network (NCCN) guidelines on Genetic/Familial High-Risk Assessment in Breast and Ovarian Cancer (v. 1.2010-1.2012). Using the 2011-2012 VA Central Cancer Registry and BRCA test orders from Myriad Genetics, we conducted a retrospective study. The outcome variable was a recommendation for genetic counseling or BRCA testing, determined by chart review. Independent variables expected to predict testing included region, site of care, and patient characteristics. We performed descriptive analysis of all patients and conducted multivariable logistic regression on patients who sought care at VAMCs that offered BRCA testing. Of the 462 Veterans who met NCCN testing criteria, 126 (27 %) received guideline-concordant care, either a referral for counseling or actual testing. No BRCA testing was recommended in 49 (50 %) VAMCs that provide cancer treatment. Surprisingly, patients with second primary breast cancer were less likely to be referred/tested (OR 0.39; CI 0.17, 0.89; p = 0.025). For patients under age 51, a yearly increase in age decreased likelihood of referral or testing (OR 0.85; CI 0.76, 0.94; p < 0.001). There were no differences in testing by race. In conclusion, there was significant underutilization and lack of access to BRCA testing for Veterans diagnosed with breast cancer. Our research suggests the need for clinical decision support tools to facilitate delivery of guideline-concordant cancer care and improve Veteran access to BRCA testing.
Details
- Title: Subtitle
- BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines
- Creators
- Danielle S Chun - University of UtahBrygida Berse - Boston UniversityVickie L VenneScott L DuVall - University of UtahKelly K Filipski - National Cancer Institute, 9609 Medical Center Drive, Rm. 4E228, MSC 9763, Rockville, Bethesda, MD, 20892, USA.Michael J Kelley - Duke UniversityLaurence J Meyer - University of UtahMichael S Icardi - University of IowaJulie A Lynch - RTI International
- Resource Type
- Journal article
- Publication Details
- Familial cancer, Vol.16(1), pp.41-49
- DOI
- 10.1007/s10689-016-9921-5
- PMID
- 27589855
- ISSN
- 1389-9600
- eISSN
- 1573-7292
- Grant note
- name: Department of Veterans Affairs Informatics and Computing Infrastructure, award: VA HSR RES 13-457; DOI: 10.13039/100000054, name: National Cancer Institute, award: IAA 14001-0000-01001
- Language
- English
- Date published
- 01/2017
- Academic Unit
- Pathology
- Record Identifier
- 9984201252702771
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