Illustration: (charts) Centers for Disease Control and Prevention; (cells) National Cancer Institute
Women who are carriers of mutated BRCA genes are known to have a significantly higher risk for developing breast and ovarian cancers than those who don’t. But a new UCLA study questions the value of screening for the genetic mutations in the general population — including those who do not have cancer or have no family history of the disease — because of the high cost. The UCLA researchers found that compared with universal screening, other diagnostic tools remain more efficient and might be more cost-effective.
The researchers concluded the BRCA genetic test that is most widely used today, which costs about $4,000, is too expensive to warrant universal screening, given how rare BRCA mutations are. “The cost of BRCA testing would need to drop by 90 percent for testing to be cost-effective for the whole population,” says Patricia Ganz, MD ’73 (RES ’76, FEL ’78), director of the Division of Cancer Prevention and Control Research at UCLA’s Jonsson Comprehensive Cancer Center.
Dr. Ganz and a colleague in the UCLA Anderson School of Management calculated that for every 10,000 women screened, BRCA screening could avert four cases of breast cancer and two cases of ovarian cancer more than would family-history-based testing. But the BRCA screening would only extend patients’ lives by an average of two days. For 99.75 percent of women screened, a negative genetic test offers no increase in life expectancy, nor would it eliminate the need for regular mammograms, and it could provide false reassurance that a woman is not at risk for breast cancer.
Harmful BRCA gene mutations are more likely to be found in families affected by breast and ovarian cancers, and carriers can pass the mutated genes to both daughters and sons. Those who carry a BRCA mutation are thought to have a 45-to-80-percent lifetime risk of developing breast cancer. Women carrying the BRCA-1 mutation have up to a 39-percent lifetime risk; women with BRCA-2 have a 10-to-17-percent lifetime risk for ovarian cancer.
The U.S. Preventive Services Task Force advises BRCA genetic testing only for women with a known family history of breast, ovarian, tubal or peritoneal cancer.
“It’s like looking for a needle in a haystack,” says Elisa Long, PhD, Dr. Ganz’s co-investigator. “If only one-in-400 women across the country has one or both of the BRCA-1 or BRCA-2 mutations, universal screening would cost $1 million to $2 million to detect a single BRCA mutation, or nearly $400 billion to screen all women in the U.S. Perhaps this money could be better spent on other diagnostic tools for young women, such as magnetic resonance imaging, to have the greatest impact.”
“Cost-effectiveness of Universal BRCA1/2 Screening Evidence-based Decision Making,” JAMA Oncology, September 3, 2015