Research Article| Volume 170, P32-37, March 2023

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Missed opportunities in the real-world genetic testing in BRCA gene variant carriers with cancers meeting NCCN criteria

Published:January 05, 2023DOI:


      • Most patients with a BRCA pathogenic variant and associated cancer underwent genetic testing following a cancer diagnosis.
      • 73% of these patients also met criteria by family history and may have qualified for earlier genetic testing.
      • Early identification of patients at high risk for pathogenic variants is critical in improving cancer risk-reduction.



      The objective of this study was to determine the proportion of patients meeting the National Comprehensive Cancer Network (NCCN)’s BRCA genetic testing criteria prior to a diagnosis of a BRCA-related cancer.


      This was a cross-sectional study of patients with BRCA pathogenic variants and a diagnosis of a BRCA-related cancer. Patients were included if they had known dates of genetic testing and cancer diagnosis. NCCN criteria (version 2.2021) were applied to determine if patients met criteria for testing before a BRCA-related cancer diagnosis. The outcome of interest was the proportion of patients undergoing genetic testing following a diagnosis of a BRCA-related cancer who qualified for genetic testing based on NCCN criteria. Chi-square, Mann-Whitney U test, and logistic regression were performed with significance at p < 0.05.


      Of 270 patients with a BRCA-related cancer, 229 (85%) underwent genetic testing after a cancer diagnosis. Most patients (97%) met at least one NCCN criteria for BRCA testing; 166 (73%) of patients who were tested following a BRCA-related cancer diagnosis also met the criteria for testing by family history. Publicly insured or uninsured patients were three times more likely to undergo BRCA testing after a diagnosis of cancer (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.09–8.40). Patients with a family history of pathogenic variants were more likely to undergo testing before a cancer diagnosis (OR 0.10, 95% CI 0.05–0.23).


      Most patients with BRCA-associated cancers undergo genetic testing after their cancer diagnosis. Increased education on genetic testing criteria and novel methods to improve testing are desperately needed.


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