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BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines.

Publication ,  Journal Article
Chun, DS; Berse, B; Venne, VL; DuVall, SL; Filipski, KK; Kelley, MJ; Meyer, LJ; Icardi, MS; Lynch, JA
Published in: Fam Cancer
January 2017

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.

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Published In

Fam Cancer

DOI

EISSN

1573-7292

Publication Date

January 2017

Volume

16

Issue

1

Start / End Page

41 / 49

Location

Netherlands

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
  • Guideline Adherence
  • Genetic Testing
  • Genetic Counseling
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chun, D. S., Berse, B., Venne, V. L., DuVall, S. L., Filipski, K. K., Kelley, M. J., … Lynch, J. A. (2017). BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines. Fam Cancer, 16(1), 41–49. https://doi.org/10.1007/s10689-016-9921-5
Chun, Danielle S., Brygida Berse, Vickie L. Venne, Scott L. DuVall, Kelly K. Filipski, Michael J. Kelley, Laurence J. Meyer, Michael S. Icardi, and Julie A. Lynch. “BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines.Fam Cancer 16, no. 1 (January 2017): 41–49. https://doi.org/10.1007/s10689-016-9921-5.
Chun DS, Berse B, Venne VL, DuVall SL, Filipski KK, Kelley MJ, et al. BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines. Fam Cancer. 2017 Jan;16(1):41–9.
Chun, Danielle S., et al. “BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines.Fam Cancer, vol. 16, no. 1, Jan. 2017, pp. 41–49. Pubmed, doi:10.1007/s10689-016-9921-5.
Chun DS, Berse B, Venne VL, DuVall SL, Filipski KK, Kelley MJ, Meyer LJ, Icardi MS, Lynch JA. BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines. Fam Cancer. 2017 Jan;16(1):41–49.
Journal cover image

Published In

Fam Cancer

DOI

EISSN

1573-7292

Publication Date

January 2017

Volume

16

Issue

1

Start / End Page

41 / 49

Location

Netherlands

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
  • Guideline Adherence
  • Genetic Testing
  • Genetic Counseling
  • Female