Abstract P4-12-11: Patient perceptions of the impact of genetic testing for breast cancer risk on health insurance
Authors: Hofstatter Erin , Chagpar Anees 
Published: May 2015

Abstract
Introduction: Genetic testing for breast cancer risk is increasingly available, and patients’ perceptions regarding how results may affect their health insurance may affect their likelihood to opt for testing. We sought to determine the changes in patient perceptions regarding the impact of genetic testing on health insurance over a five year period from 2005 to 2010. Notably, during this time period two significant U.S. federal health care laws were enacted. First, the Genetic Information Nondiscrimination Act (GINA) passed in 2008, protecting against the use of genetic information for health insurance coverage. Second, the Patient Protection and Affordable Care Act (PPACA) passed in 2010, representing a major regulatory overhaul of the U.S. health care system, promising universal access to health care coverage.
Methods: The National Health Interview Survey is a population-based face-to-face survey conducted annually by the CDC. In 2005 and in 2010, a cancer supplement was fielded which asked respondents who had undergone genetic testing whether they felt this had, or would, affect their health insurance. We evaluated the cohort of participants who had undergone genetic testing for breast cancer, and used SUDAAN statistical software to evaluate changes in the proportion who felt genetic testing would adversely affect their health insurance, and factors associated with this perception.
Results: In 2005, 48 respondents had undergone genetic testing for breast cancer, representing 333,544 people in the population. Of these, 16.8% felt that genetic testing had, or would, affect their health insurance. In 2010, 16 respondents had undergone genetic testing for breast cancer, representing 93,301 people in the population. Of these, 17.4% felt that genetic testing had, or would affect their health insurance. In 2005, this perception varied based on insurance status, education, and region; but in 2010, perceptions of the impact of genetic testing on health insurance were unaffected by these factors.
Patient Perception of Genetic Testing Effect on Health Insurance 20052010 %p-value%p-valueInsurance 0.006 0.276Uninsured11.8 22.8 Medicaid0 59.5 Medicare28.7 7.0 Private15.7 18.8 Other35.4 0 Education 0.031 0.463&lt; Grade 128.7 7.9 High School/GED0 17.2 Some college0 19.0 Associates34.5 19.5 Bachelors34.2 5.6 Masters/Prof/Doctorate38.3 42.5 Region 0.077 0.122Northeast35.3 30.3 Midwest17.0 6.1 South3.2 29.1 West5.8 10.7 Age 0.449 0.463&lt;5526.2 14.0 &gt;5512.2 21.1
Conclusion: More people undergoing genetic testing for breast cancer risk in 2010 were concerned that this would adversely affect their health insurance than in 2005, and there was less variation in this perception based on insurance, education and region than in the earlier period. We conclude that, despite the passage of significant U.S. legislation including GINA and PPACA, nearly 1 in 5 people undergoing genetic testing remained concerned about potential risk to their health insurance coverage. Accurate and early identification of those people carrying a cancer genetic mutation is crucial to cancer prevention and treatment efforts; our results suggest a dire need for improved education regarding federal protections for genetic testing so that any barriers to seeking genetic counseling are eliminated.
Citation Format: Erin Hofstatter, Anees Chagpar. Patient perceptions of the impact of genetic testing for breast cancer risk on health insurance [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-12-11.