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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-...

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Autores principales: Foroughi, Olivia, Madraswala, Shaheen, Hayes, Jennifer, Glover, Kara, Lee, Liam, Chaki, Moumita, Redpath, Stella, Yu, Agnes Weixuan, Chiu, David, Amanti, Kristen Garner, Gustavsen, Gary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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.
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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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