title: BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines.
abstract: Guideline-concordant cancer care is a priority within the Department of Veterans Affairs (VA). In 2009, the VA expanded its capacity to treat breast cancer patients within VA medical centers (VAMCs). We sought to determine whether male and female Veterans diagnosed with breast cancer received BRCA testing as recommended by the National Comprehensive Cancer Network (NCCN) guidelines on Genetic/Familial High-Risk Assessment in Breast and Ovarian Cancer (v. 1.2010-1.2012). Using the 2011-2012 VA Central Cancer Registry and BRCA test orders from Myriad Genetics, we conducted a retrospective study. The outcome variable was a recommendation for genetic counseling or BRCA testing, determined by chart review. Independent variables expected to predict testing included region, site of care, and patient characteristics. We performed descriptive analysis of all patients and conducted multivariable logistic regression on patients who sought care at VAMCs that offered BRCA testing. Of the 462 Veterans who met NCCN testing criteria, 126 (27 %) received guideline-concordant care, either a referral for counseling or actual testing. No BRCA testing was recommended in 49 (50 %) VAMCs that provide cancer treatment. Surprisingly, patients with second primary breast cancer were less likely to be referred/tested (OR 0.39; CI 0.17, 0.89; p = 0.025). For patients under age 51, a yearly increase in age decreased likelihood of referral or testing (OR 0.85; CI 0.76, 0.94; p < 0.001). There were no differences in testing by race. In conclusion, there was significant underutilization and lack of access to BRCA testing for Veterans diagnosed with breast cancer. Our research suggests the need for clinical decision support tools to facilitate delivery of guideline-concordant cancer care and improve Veteran access to BRCA testing.
authors: VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.|University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
authors: Danielle S
authors: DS
authors: Chun
authors: Veterans Health Administration, 200 Springs Rd, Bedford, MA, 01730, USA.|Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA.|RTI International, 307 Waverley Oaks Rd, Waltham, MA, 02452, USA.
authors: Brygida
authors: B
authors: Berse
authors: VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
authors: Vickie L
authors: VL
authors: Venne
authors: VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.|University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
authors: Scott L
authors: SL
authors: DuVall
authors: National Cancer Institute, 9609 Medical Center Drive, Rm. 4E228, MSC 9763, Rockville, Bethesda, MD, 20892, USA.
authors: Kelly K
authors: KK
authors: Filipski
authors: Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA.|Duke University, 508 Fulton St, Hem-onc 111G, Durham, NC, 27705, USA.
authors: Michael J
authors: MJ
authors: Kelley
authors: VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.|University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
authors: Laurence J
authors: LJ
authors: Meyer
authors: Veterans Health Administration, 601 Highway 6 West, Iowa City, IA, 52246-2208, USA.|University of Iowa, 601 Highway 6 West, Iowa City, IA, 52246-2208, USA.
authors: Michael S
authors: MS
authors: Icardi
authors: University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA. Julie.Lynch@va.gov.|RTI International, 307 Waverley Oaks Rd, Waltham, MA, 02452, USA. Julie.Lynch@va.gov.|VA Salt Lake City Health Care System, 200 Springs Road, Bedford, MA, 01730, USA. Julie.Lynch@va.gov.
authors: Julie A
authors: JA
authors: Lynch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics*; D005260:Female; D005817:Genetic Counseling; D005820:Genetic Testing / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: BRCA; Breast cancer; Clinical guidelines; Genetic testing