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 and 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 the deprivation group which adjusts for confounders.
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This study was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC). The investigators were solely responsible for the content and the decision to submit the paper for publication. The funding source had no role in the selection, critical appraisal, or synthesis of evidence. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
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APM, JD, BC, AA, MP, and KLG were involved with the conception and design of the study. APM, JD, MP, and KLG were involved with acquisition of data. APM, GP, BC, AA, BG, MP, and KLG were responsible for analysis and interpretation of data. APM, KLG, and MP are responsible for overall content as guarantors. All authors contributed to drafting the article, revising it critically for important intellectual content, and had final approval of the version to be published.
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Martin, A.P., Pedra, G., Downing, J. et al. Trends in BRCA testing and socioeconomic deprivation. Eur J Hum Genet 27, 1351–1360 (2019). https://doi.org/10.1038/s41431-019-0424-3
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DOI: https://doi.org/10.1038/s41431-019-0424-3
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