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Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer
Despite the OlympiA trial demonstrating that early-stage, high-risk, HER2- germline BRCA1 and BRCA2 mutation (gBRCAm) positive breast cancer patients can benefit from PARPi in the adjuvant setting, the gBRCA testing rate in early-stage HR+/HER2− patients remains suboptimal compared to that in early-...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455724/ https://www.ncbi.nlm.nih.gov/pubmed/37623478 http://dx.doi.org/10.3390/jpm13081228 |
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author | Foroughi, Olivia Madraswala, Shaheen Hayes, Jennifer Glover, Kara Lee, Liam Chaki, Moumita Redpath, Stella Yu, Agnes Weixuan Chiu, David Amanti, Kristen Garner Gustavsen, Gary |
author_facet | Foroughi, Olivia Madraswala, Shaheen Hayes, Jennifer Glover, Kara Lee, Liam Chaki, Moumita Redpath, Stella Yu, Agnes Weixuan Chiu, David Amanti, Kristen Garner Gustavsen, Gary |
author_sort | Foroughi, Olivia |
collection | PubMed |
description | Despite the OlympiA trial demonstrating that early-stage, high-risk, HER2- germline BRCA1 and BRCA2 mutation (gBRCAm) positive breast cancer patients can benefit from PARPi in the adjuvant setting, the gBRCA testing rate in early-stage HR+/HER2− patients remains suboptimal compared to that in early-stage TNBC patients. To better understand the perceived barriers associated with gBRCA testing in HR+/HER2− disease, a quantitative survey was conducted across stakeholders (n = 430) including medical oncologists, surgeons, nurses, physician assistants, payers, and patients. This study revealed that while payers claim to cover gBRCA testing, poor clinician documentation and overutilization are key challenges. Therefore, payers place utilization management controls on gBRCA testing due to their impression that clinicians overtest. These controls have led to healthcare professionals experiencing payer pushback in the form of reimbursement limitations and denials. The perceived challenges to gBRCA testing stem from the lack of consensus dictating which patients are high risk and should be tested. While payers define high risk based on the CPS + EG score from the OlympiA trial, HCPs adopt a broader definition including genomic risk scores, lymph node involvement, and tumor grade and size. A dialogue to harmonize risk classification and testing eligibility across stakeholders is critical to address this disconnect and increase gBRCA testing in appropriate patients. |
format | Online Article Text |
id | pubmed-10455724 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104557242023-08-26 Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer Foroughi, Olivia Madraswala, Shaheen Hayes, Jennifer Glover, Kara Lee, Liam Chaki, Moumita Redpath, Stella Yu, Agnes Weixuan Chiu, David Amanti, Kristen Garner Gustavsen, Gary J Pers Med Article Despite the OlympiA trial demonstrating that early-stage, high-risk, HER2- germline BRCA1 and BRCA2 mutation (gBRCAm) positive breast cancer patients can benefit from PARPi in the adjuvant setting, the gBRCA testing rate in early-stage HR+/HER2− patients remains suboptimal compared to that in early-stage TNBC patients. To better understand the perceived barriers associated with gBRCA testing in HR+/HER2− disease, a quantitative survey was conducted across stakeholders (n = 430) including medical oncologists, surgeons, nurses, physician assistants, payers, and patients. This study revealed that while payers claim to cover gBRCA testing, poor clinician documentation and overutilization are key challenges. Therefore, payers place utilization management controls on gBRCA testing due to their impression that clinicians overtest. These controls have led to healthcare professionals experiencing payer pushback in the form of reimbursement limitations and denials. The perceived challenges to gBRCA testing stem from the lack of consensus dictating which patients are high risk and should be tested. While payers define high risk based on the CPS + EG score from the OlympiA trial, HCPs adopt a broader definition including genomic risk scores, lymph node involvement, and tumor grade and size. A dialogue to harmonize risk classification and testing eligibility across stakeholders is critical to address this disconnect and increase gBRCA testing in appropriate patients. MDPI 2023-08-03 /pmc/articles/PMC10455724/ /pubmed/37623478 http://dx.doi.org/10.3390/jpm13081228 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Foroughi, Olivia Madraswala, Shaheen Hayes, Jennifer Glover, Kara Lee, Liam Chaki, Moumita Redpath, Stella Yu, Agnes Weixuan Chiu, David Amanti, Kristen Garner Gustavsen, Gary Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer |
title | Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer |
title_full | Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer |
title_fullStr | Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer |
title_full_unstemmed | Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer |
title_short | Barriers to gBRCA Testing in High-Risk HER2-Negative Early Breast Cancer |
title_sort | barriers to gbrca testing in high-risk her2-negative early breast cancer |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455724/ https://www.ncbi.nlm.nih.gov/pubmed/37623478 http://dx.doi.org/10.3390/jpm13081228 |
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