Trends in BRCA testing and socioeconomic deprivation

Martin, Antony P. and Pedra, Gabriel and Downing, Jennifer and Collins, Brendan and Godman, Brian and Alfirevic, Ana and Pirmohamed, Munir and Greenhalgh, Kathryn (2019) Trends in BRCA testing and socioeconomic deprivation. European Journal of Human Genetics, 27 (9). pp. 1351-1360. ISSN 1018-4813 (https://doi.org/10.1038/s41431-019-0424-3)

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Abstract

BRCA testing received much publicity following Angelina Jolie’s editorial ‘My Medical Choice’ in May 2013 and updated NICE clinical guidance (CG164) in June 2013. We assessed the effect of these two concurrent events on BRCA testing in one UK catchment area and relate this to socioeconomic deprivation. A database of 1393 patients who received BRCA testing was collated. This included individuals with breast/ovarian cancer, and those unaffected by cancer, where a relative has a ≥10% probability of carrying a BRCA variant which affects function. A segmented regression was conducted to estimate changes in testing. To examine the relative distribution of testing by deprivation, the deprivation status of patients who received testing was examined. Between April 2010-March 2017, testing increased 11-fold and there was an 84% increase (P=0.006) in BRCA1/2 testing in the month following both publications. In the pre-publication period, there was no statistically significant difference in testing between advantaged and disadvantaged areas (OR 1.21 95% CI 0.99-1.48; P=0.06). In the post-publication period helped by a larger sample size, the difference was statistically significant (OR 1.18 95% CI 1.08-1.29; P=0.0002) and of a similar magnitude to the pre-publication period. Testing increased following Jolie’s editorial and NICE guidance update. However further research is needed to examine differences in testing by deprivation group which adjusts for confounders.

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