According to findings from a new analysis published in JAMA Oncology, multigene testing should be expanded to all women with breast cancer and not just those with certain family histories or clinical factors.
Researchers conducted a microsimulation model comparing multigene BRCA1, BRCA2, and PALB2 testing in all women with breast cancer to BRCA1 and BRCA2 testing in just women with a family history of breast cancer or clinical factors. They used pooled data from 11,836 patients in four large studies to assess the impact on potential prevention and death rates as well as cost effectiveness based on quality-adjusted life-year (QALY).
Their model identified that multigene testing for all U.S. patients with breast cancer could prevent 9,733 cases of breast or ovarian cancer and prevent 2,406 deaths per year. Additionally, it would cost between $61,618 and $65,661 per QALY in the United States, significantly less than minimum willingness-to-pay threshold of $100,000 per QALY.
The researchers noted that the U.S. Preventive Services Task Force currently recommends against genetic counseling and testing for women without a personal or family history associated with BRCA1 or BRCA2 mutations. They suggested conducting a value-of-information analysis, the results of which could be used to determine whether a recommendation change is needed.