Usefulness of Canadian Public Health Insurance Administrative Databases to Assess Breast and Ovarian Cancer Screening Imaging Technologies for BRCA1/2 Mutation Carriers.
OBJECTIVE
In Canada, recommendations for clinical management of hereditary breast and ovarian cancer among individuals carrying a deleterious BRCA1 or BRCA2 mutation have been available since 2007. Eight years later, very little is known about the uptake of screening and risk-reduction measures in this population. Because Canada's public health care system falls under provincial jurisdictions, using provincial health care administrative databases appears a valuable option to assess management of BRCA1/2 mutation carriers. The objective was to explore the usefulness of public health insurance administrative databases in British Columbia, Ontario, and Quebec to assess management after BRCA1/2 genetic testing.


METHODS
Official public health insurance documents were considered potentially useful if they had specific procedure codes, and pertained to procedures performed in the public and private health care systems.


RESULTS
All 3 administrative databases have specific procedures codes for mammography and breast ultrasounds. Only Quebec and Ontario have a specific procedure code for breast magnetic resonance imaging. It is impossible to assess, on an individual basis, the frequency of others screening exams, with the exception of CA-125 testing in British Columbia. Screenings done in private practice are excluded from the administrative databases unless covered by special agreements for reimbursement, such as all breast imaging exams in Ontario and mammograms in British Columbia and Quebec. There are no specific procedure codes for risk-reduction surgeries for breast and ovarian cancer.


CONCLUSIONS
Population-based assessment of breast and ovarian cancer risk management strategies other than mammographic screening, using only administrative data, is currently challenging in the 3 Canadian provinces studied.
Faculté de pharmacie, Université Laval, Ville de Québec, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Ville de Québec, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Ville de Québec, Québec, Canada.
Geneviève
G
Larouche
Centre de recherche du CHU de Québec - Université Laval, Ville de Québec, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Ville de Québec, Québec, Canada; Centre des maladies du sein Deschênes-Fabia, Ville de Québec, Québec, Canada; Faculté de médecine, Université Laval, Ville de Québec, Québec, Canada.
Jocelyne
J
Chiquette
Centre de recherche du CHU de Québec - Université Laval, Ville de Québec, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Ville de Québec, Québec, Canada; Faculté de médecine, Université Laval, Ville de Québec, Québec, Canada; Département d'obstétrique et de gynécologie, CHU de Québec - Université Laval, Ville de Québec, Québec, Canada.
Marie
M
Plante
Centre de recherche du CHU de Québec - Université Laval, Ville de Québec, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Ville de Québec, Québec, Canada.
Sylvie
S
Pelletier
Centre de recherche du CHU de Québec - Université Laval, Ville de Québec, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Ville de Québec, Québec, Canada; Faculté de médecine, Université Laval, Ville de Québec, Québec, Canada.
Jacques
J
Simard
Faculté de pharmacie, Université Laval, Ville de Québec, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Ville de Québec, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Ville de Québec, Québec, Canada; Centre des maladies du sein Deschênes-Fabia, Ville de Québec, Québec, Canada. Electronic address: michel.dorval@crchudequebec.ulaval.ca.
Michel
M
Dorval
D000067575:Administrative Claims, Healthcare; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics; D001955:British Columbia; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D007348:Insurance, Health; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008327:Mammography / Q000706:statistics & numerical data; D009313:National Health Programs; D009864:Ontario; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics; D011792:Quebec; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data
Breast neoplasms/prevention and control; Genes BRCA1; Genes BRCA2; Hereditary breast and ovarian cancer syndrome; National Health Programs; Ovarian neoplasms/prevention and control