Abstract B34: Patterns of BRCA testing at a safety net compared to a university hospital
Authors: Smith Demetria J. , Sauter Christopher , Zhang Chao , Chen Zhengjia , Gogineni Keerthi 
Published: February 2019

Abstract
Introduction: The criteria for coverage of BRCA testing vary by insurance company, and out-of-pocket costs can be prohibitive for many. Previous studies investigating rates of BRCA testing analyzed patient populations consisting of predominantly white women and women with private insurance. This study compares the differences in rates of BRCA testing among women diagnosed with breast cancer at a safety net hospital affiliated with an academic medical center and a tertiary-care university hospital in order to determine any factors associated with or predictive of testing differences.
Methods: Retrospective chart review was performed using a dataset obtained from the Georgia Tumor Registry of women seen at Grady Memorial Hospital (GMH) and Emory University Hospital (EUH) between 2010 and 2014 who were diagnosed with breast cancer between the ages of 20-70. Of the 1,142 EUH cases, 652 charts were randomly selected and all 532 GMH cases have been reviewed to date. Demographic information collected included age, race, insurance status, type of insurance, and mean and median household income based on zip code of residence. Records were reviewed for documentation of referral to genetic counseling, if testing was performed, and testing results. National Comprehensive Cancer Network (NCCN) guidelines for BRCA testing were used in the study to identify high-risk patients. Data analysis was performed using univariate analysis and multivariable logistic regression.
Results: Data from 529 EUH charts and 468 GMH charts were included in the final analysis. Among GMH patients, 81.4% were black/African American, 5.6% were white/Caucasian, and 7.9% were Hispanic/Latina. Mean age at diagnosis was 49.3 (SD 8.1). Mean household income for GMH patients was $60,292 (SD $22,975). At time of diagnosis, 37.2% of GMH patients had Medicaid, 7.7% had Medicare, 24.4% had private insurance, and 29.9% were uninsured. Among EUH patients, 35.7% were black, 56.9% were white, and 1.1% were Latina. Mean age at diagnosis was 48.84 (SD 7.61). Mean household income of EUH patients was $82,284 (SD $30,422). At time of diagnosis, 13.4% of EUH patients had Medicaid, 1.3% had Medicare, 84.3% had private insurance, and 0.8% were uninsured. Black patients were more likely to be high risk. High-risk patients were tested at a higher rate than low-risk patients (38% vs 8%, p &lt;0.001). There was a higher proportion of high-risk patients at GMH than EUH, although this did not meet statistical significance (p= 0.075). There was a higher rate of BRCA testing among women at EUH vs GMH (35% vs 15%, p &lt; 0.001) and white women vs black women (36% vs 18%, p &lt; 0.001). BRCA testing also occurred at a higher rate among women with private insurance and women who lived in zip codes with a higher median income. However, this difference was not statistically significant in the multivariable logistic regression.
Conclusion: Hospital- and race-related disparities in rates of BRCA testing exist despite both hospitals being staffed by the same university-based oncology faculty. The data also suggest disparities related to insurance status and income. This raises concern for financial and logistical barriers impeding genetic counseling and testing in a safety net hospital setting despite a higher proportion of high-risk patients. Analysis is ongoing to determine whether high-risk patients are less likely to undergo BRCA testing in a safety net hospital compared to a university hospital setting. Interventions to increase BRCA testing and counseling among high-risk breast cancer patients must be adapted to meet the challenges of resource-poor settings.
Citation Format: Demetria J. Smith, Christopher Sauter, Chao Zhang, Zhengjia Chen, Keerthi Gogineni. Patterns of BRCA testing at a safety net compared to a university hospital [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B34.