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BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas - United States, 2009-2014.

Abstract Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title morbidity and mortality weekly report. surveillance summaries (washington, d.c. : 2002)
Publication Year Start




PMID- 28880857
OWN - NLM
STAT- In-Process
DA  - 20170907
LR  - 20170907
IS  - 1545-8636 (Electronic)
IS  - 0892-3787 (Linking)
VI  - 66
IP  - 15
DP  - 2017 Sep 08
TI  - BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged
      18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and
      Metropolitan Areas - United States, 2009-2014.
PG  - 1-11
LID - 10.15585/mmwr.ss6615a1 [doi]
AB  - PROBLEM/CONDITION: Genetic testing for breast cancer 1 (BRCA1) and breast cancer 
      2 (BRCA2) gene mutations can identify women at increased risk for breast and
      ovarian cancer. These testing results can be used to select preventive
      interventions and guide treatment. Differences between nonmetropolitan and
      metropolitan populations in rates of BRCA testing and receipt of preventive
      interventions after testing have not previously been examined. PERIOD COVERED:
      2009-2014. DESCRIPTION OF SYSTEM: Medical claims data from Truven Health
      Analytics MarketScan Commercial Claims and Encounters databases were used to
      estimate rates of BRCA testing and receipt of preventive interventions after BRCA
      testing among women aged 18-64 years with employer-sponsored health insurance in 
      metropolitan and nonmetropolitan areas of the United States, both nationally and 
      regionally. RESULTS: From 2009 to 2014, BRCA testing rates per 100,000 women aged
      18-64 years with employer-sponsored health insurance increased 2.3 times (102.7
      to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan 
      areas. The relative difference in BRCA testing rates between metropolitan and
      nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in
      2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between 
      metropolitan and nonmetropolitan areas decreased more over time in younger women 
      than in older women and decreased in all regions except the West. Receipt of
      preventive services 90 days after BRCA testing in metropolitan versus
      nonmetropolitan areas throughout the period varied by service: the percentage of 
      women who received a mastectomy was similar, the percentage of women who received
      magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as
      low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low
      as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who
      received mammography was lower in nonmetropolitan areas in earlier years but was 
      similar in later years. INTERPRETATION: Possible explanations for the 47%
      decrease in the relative difference in BRCA testing rates over the study period
      include increased access to genetic services in nonmetropolitan areas and
      increased demand nationally as a result of publicity. The relative differences in
      metropolitan and nonmetropolitan BRCA testing rates were smaller among women at
      younger ages compared with older ages. PUBLIC HEALTH ACTION: Improved data
      sources and surveillance tools are needed to gather comprehensive data on BRCA
      testing in the United States, monitor adherence to evidence-based guidelines for 
      BRCA testing, and assess receipt of preventive interventions for women with BRCA 
      mutations. Programs can build on the recent decrease in geographic disparities in
      receipt of BRCA testing while simultaneously educating the public and health care
      providers about U.S. Preventive Services Task Force recommendations and other
      clinical guidelines for BRCA testing and counseling.
FAU - Kolor, Katherine
AU  - Kolor K
AD  - Office of Public Health Genomics, Division of Public Health Information
      Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services,
      CDC, Atlanta, Georgia.
FAU - Chen, Zhuo
AU  - Chen Z
AD  - Office of Public Health Genomics, Division of Public Health Information
      Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services,
      CDC, Atlanta, Georgia.
AD  - CFO Leasing, Inc., Atlanta, Georgia.
AD  - Department of Health Policy and Management, College of Public Health, University 
      of Georgia, Athens, Georgia.
FAU - Grosse, Scott D
AU  - Grosse SD
AD  - National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta,
      Georgia.
FAU - Rodriguez, Juan L
AU  - Rodriguez JL
AD  - Division of Cancer Prevention and Control, National Center for Chronic Disease
      Prevention and Health Promotion, CDC, Atlanta, Georgia.
FAU - Green, Ridgely Fisk
AU  - Green RF
AD  - Office of Public Health Genomics, Division of Public Health Information
      Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services,
      CDC, Atlanta, Georgia.
AD  - Carter Consulting, Inc., Atlanta, Georgia.
FAU - Dotson, W David
AU  - Dotson WD
AD  - Office of Public Health Genomics, Division of Public Health Information
      Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services,
      CDC, Atlanta, Georgia.
FAU - Bowen, M Scott
AU  - Bowen MS
AD  - Office of Public Health Genomics, Division of Public Health Information
      Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services,
      CDC, Atlanta, Georgia.
FAU - Lynch, Julie A
AU  - Lynch JA
AD  - US Department of Veterans Affairs Salt Lake City Healthcare System, Salt Lake
      City, Utah.
FAU - Khoury, Muin J
AU  - Khoury MJ
AD  - Office of Public Health Genomics, Division of Public Health Information
      Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services,
      CDC, Atlanta, Georgia.
LA  - eng
PT  - Journal Article
DEP - 20170908
PL  - United States
TA  - MMWR Surveill Summ
JT  - Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. :
      2002)
JID - 101142015
EDAT- 2017/09/08 06:00
MHDA- 2017/09/08 06:00
CRDT- 2017/09/08 06:00
AID - 10.15585/mmwr.ss6615a1 [doi]
PST - epublish
SO  - MMWR Surveill Summ. 2017 Sep 8;66(15):1-11. doi: 10.15585/mmwr.ss6615a1.