Abstract P4-06-01: Provider practice and compliance with NCCN clinical guidelines for BRCA1/2 testing: Findings from Dr. Susan Love Research Foundation's The Health of Women (HOW) StudyTM
Authors: Roberts MC , Loud J , Klein WMP , Silver MI 
Published: February 2018

Abstract
BRCA1/2-attributable cancers disproportionately contribute to breast cancer mortality, but are relatively infrequent in the general population, making healthcare practices surrounding BRCA1/2 mutation carrier status difficult to study. This analysis leverages a large dataset of over 40,000 individuals with and without breast cancer from Dr. Susan Love Research Foundation's The Health of Women (HOW) StudyTM to evaluate factors associated with healthcare provider compliance with National Comprehensive Cancer Network (NCCN) guidelines for BRCA1/2 testing. Data from women ages 18 and older who completed baseline and family history questionnaires were included in our sample (n=22,410). We examined whether: (1) genetic testing receipt was aligned with NCCN guidelines for BRCA1/2 genetic testing, (2) guideline-consistent use of BRCA1/2 testing varied by race and education, (3) those who had genetic testing received pre-test genetic counseling, and (4) guideline-consistent BRCA1/2 testing differed among those who received pre-test genetic counseling. In this population, 4326 women (19.5%) reported BRCA1/2 testing. Of these women, 70.3% of women were eligible for testing based on NCCN guidelines (vs. 29.8% who did not qualify). Women with higher levels of education were less likely to be over-tested or under-tested than those with lower levels of education (p&lt;0.001); no differences were observed by Hispanic ethnicity (Hispanic vs. non-Hispanic, p=.71) or race (white vs. non-white, p=0.23). Among those tested for BRCA1/2, 65.6% (n=2976) received pre-test genetic counseling. Those who received pretest counseling were more likely to receive genetic testing consistent with NCCN guidelines than those who did not receive pretest counseling (73.8% vs 63.6%, p&lt;0.001). 58% received post-test counseling by a genetics provider (n=2515) compared to 33.9% who received genetic results from their primary care provider or another provider (n=1465). Those who received genetic test results from a genetics provider were more likely to have received BRCA1/2 testing that was compliant with NCCN guidelines than those who received their genetic test results from another type of provider, though by a modest amount (74.2% vs 70.6%, p=0.01). In this population, we found that pretest-genetic counseling was associated with higher rates of NCCN guideline-consistent recommendations for BRCA1/2 genetic testing, and a woman's educational level appears to be associated with higher rates of guideline concordant use of BRCA1/2 testing. Overall, these findings showed higher rates of BRCA1/2 testing and receipt of counseling than previously reported, which may be partially reflective of this unique study population of motivated volunteers. As genetics is increasingly incorporated into cancer prevention, there is an urgent need to examine adherence to genetic testing guidelines to ensure appropriate use.
Citation Format: Roberts MC, Loud J, Klein WMP, Silver MI. Provider practice and compliance with NCCN clinical guidelines for BRCA1/2 testing: Findings from Dr. Susan Love Research Foundation's The Health of Women (HOW) StudyTM [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-01.