Trends in Positive BRCA Test Results Among Older Women in the United States, 2008-2018.
Trends in Positive BRCA Test Results Among Older Women in the United States, 2008-2018.
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DOI：
10.1001/jamanetworkopen.2020.24358
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Berenson AB
中科院分区：
文献类型：
--
作者：
Guo F;Scholl M;Fuchs EL;Wong R;Kuo YF;Berenson AB
从2008年到2018年，美国老年女性BRCA检测结果阳性的趋势是什么？这项对5533名年龄在65岁及以上的女性进行的横断面研究发现，从2008年到2018年，记录的BRCA检测结果阳性的比例显著下降，尤其是在乳腺癌或卵巢癌患者中。检测结果呈阳性的女性更有可能是非西班牙裔黑人女性，生活在西部或南部，生活在大学毕业生比例低的地区，或者没有乳腺癌或卵巢癌的个人病史。BRCA检测结果呈阳性的比率持续下降，部分原因可能是随着时间的推移，检测标准有所放松。BRCA1/2致病变异的基因检测已被用于有针对性的、个体化的癌症预防和治疗。阳性的BRCA检测结果表明患BRCA相关癌症的风险较高。在过去的十年里，测试标准放宽了。这些放宽的标准对老年妇女BRCA检测的影响以前没有研究过。评估2008年至2018年美国老年女性BRCA检测结果阳性率是否发生变化。这项横断面研究使用了来自Optum确定的综合索赔-临床数据集（2008-2018）的65岁或以上女性的10%随机样本，这是一个大型的国家电子健康记录数据集。从2008年1月1日至2018年3月31日，共有5533名女性进行了BRCA检测。评估BRCA阳性检测结果的年百分比变化。使用多变量logistic回归模型来评估阳性检测结果与种族/民族、居住地区、收入、教育水平和乳腺癌或卵巢癌个人病史之间的关系。在2008年至2018年接受BRCA检测的5533名65岁及以上女性（平均年龄68.1岁[95% CI， 67.9-68.4岁]）中，大多数（4679名[84.6%]）是非西班牙裔白人女性，1915名（34.6%）居住在中西部。BRCA检测阳性结果从2008年的85.7%（42人中的36人）下降到2018年的55.6%（252人中的140人）（年百分比变化，- 2.55;95% CI, - 3.45至- 1.64）。在乳腺癌或卵巢癌患者中，检测阳性结果从2008年的83.3%（24人中有20人）下降到2018年的61.6%（99人中有61人），而在未患乳腺癌或卵巢癌的女性中，检测阳性结果从2008年的87.5%（24人中有21人）下降到2018年的48.4%（153人中有74人）（年百分比变化，- 3.17 vs - 2.49; P = 0.29）。检测结果呈阳性的女性更有可能是非西班牙裔黑人女性，生活在西部或南部，生活在大学毕业生比例低的地区，或者没有乳腺癌或卵巢癌的个人病史。这项研究表明，在65岁及以上的女性中，BRCA检测结果阳性的比例显著降低。测试使用的社会经济和地区差异仍然是一个问题。这项横断面研究评估了2008年至2018年美国老年女性BRCA检测阳性结果的比率是否发生了变化。
What are the trends in positive BRCA test results among older women in the United States from 2008 to 2018? This cross-sectional study of 5533 women aged 65 years or older from a large national electronic health record data set found that the rate of documented positive BRCA test results significantly decreased from 2008 to 2018, especially among patients with breast or ovarian cancer. Women with positive test results were more likely to be non-Hispanic Black women, to live in the West or South, to live in areas with a low percentage of college graduates, or to not have a personal history of breast or ovarian cancer. The rate of positive BRCA test results has continuously decreased, which may be partly explained by loosening of testing criteria over time. Genetic testing for BRCA1/2 pathogenic variants has been used for targeted, individualized cancer prevention and treatment. A positive BRCA test result indicates a higher risk for developing BRCA-related cancers. During the past decade, testing criteria have loosened. The impact of these loosened criteria on BRCA testing in older women has not previously been studied. To assess whether the rate of positive BRCA test results changed between 2008 and 2018 among older women in the United States. This cross-sectional study used a 10% random sample of women 65 years of age or older from Optum’s deidentified Integrated Claims-Clinical data set (2008-2018), a large national electronic health record data set. A total of 5533 women with BRCA test results from January 1, 2008, to March 31, 2018, were evaluated. Annual percentage change in positive BRCA test results was evaluated. Multivariable logistic regression models were used to assess the association between positive test results and race/ethnicity, region of residence, income, educational level, and personal history of breast or ovarian cancer. Of 5533 women 65 years of age or older (mean age, 68.1 years [95% CI, 67.9-68.4 years]) who underwent BRCA testing from 2008 to 2018, most (4679 [84.6%]) were non-Hispanic White women, and 1915 (34.6%) resided in the Midwest. Positive BRCA test results decreased from 85.7% (36 of 42) in 2008 to 55.6% (140 of 252) in 2018 (annual percentage change, −2.55; 95% CI, −3.45 to −1.64). Among patients with breast or ovarian cancer, positive test results decreased from 83.3% (20 of 24) in 2008 to 61.6% (61 of 99) in 2018, while among women without breast or ovarian cancer, positive test results decreased from 87.5% (21 of 24) in 2008 to 48.4% (74 of 153) in 2018 (annual percentage change, −3.17 vs −2.49; P = .29). Women with positive test results were more likely to be non-Hispanic Black women, to live in the West or South, to live in areas with a low percentage of college graduates, or to not have a personal history of breast or ovarian cancer. This study suggests that there was a significantly decreasing rate of positive BRCA test results among women 65 years of age or older. Socioeconomic and regional disparities in testing use remain an issue. This cross-sectional study assesses whether the rate of positive BRCA test results changed between 2008 and 2018 among older women in the United States.
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影响因子：
4.7
作者：
Lancaster, Johnathan M.;Powell, C. Bethan;Richardson, Debra L.
通讯作者：
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影响因子：
39.2
作者：
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通讯作者：
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DOI：
10.6004/jnccn.2014.0127
发表时间：
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影响因子：
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DOI：
10.1097/gim.0b013e3182091ba4
发表时间：
2011-04
期刊：
Genetics in medicine : official journal of the American College of Medical Genetics
影响因子：
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作者：
Levy DE;Byfield SD;Comstock CB;Garber JE;Syngal S;Crown WH;Shields AE
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158.5
作者：
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