2017

Few women with history of breast cancer and ovarian cancer take a recommended genetic test


UCLA physician says key genetic mutation can be easily detected through blood or saliva analysis.

pencil and paper

Of the nearly 4 million women in the United States who have had either breast cancer or ovarian cancer, at least 1.5 million have a high risk of carrying certain types of genetic mutations that could increase their risk for additional cancers in the future.

And although the mutations, including those that affect the BRCA1 and BRCA2 genes, can be identified through a simple blood or saliva test, more than 80 percent of those women have not taken the test or even discussed it with a health care provider, according to a new study from the UCLA Fielding School of Public Health.

The study is published online August 18 in the peer-reviewed Journal of Clinical Oncology.

“Many of these women have inherited genetic changes that put them and their family members at risk for future cancers,” said Dr. Christopher Childers, a resident physician in the department of surgery at the David Geffen School of Medicine at UCLA and the study’s lead author. “Identifying a mutation is often important for surgical decision-making and cancer therapy, but its importance extends further than that. If individuals are aware that they have these mutations, they can take steps to lower their future cancer risk.”

Childers said people who know they have the mutations would be advised to undergo more frequent and specialized screening (such as breast MRI), consider preventive medications, undergo risk-reducing surgery or make lifestyle modifications (including improving diet and exercise habits, and stopping smoking).

Testing for BRCA1 and BRCA2 mutations, which are still the leading risk factors for inherited breast and ovarian cancer, has been available since the mid-1990s. But scientists now know that mutations in several other genes can increase the risk for breast and ovarian cancers; those mutations can also be detected by contemporary genetic tests.

The researchers examined data from the 2005, 2010 and 2015 National Health Interview Surveys, which are conducted by the Centers for Disease Control and Prevention. Then, drawing from the National Cancer Center Network’s guidelines for managing care for people with cancer, the scientists identified five criteria to determine women for whom the genetic test would be most beneficial:

  • Women who have had ovarian cancer.
  • Women who have had breast cancer, if:
    • they were diagnosed at age 45 or younger;
    • they were diagnosed at age 50 years or younger, and have a mother, sister or daughter who has had breast cancer;
    • they have a mother, sister or daughter who had breast cancer when they were 50 or younger; or
    • they have a mother, sister or daughter who has had ovarian cancer.

Of 47,218 women whose records were reviewed, 2.7 percent had had breast cancer. Among those who met at least one of these four criteria, 29 percent had discussed the genetic test with a health care provider, 20.2 percent were advised to undergo the test, and only 15.3 percent had taken it.

Some 0.4 percent of women in the survey had had ovarian cancer. Of them, 15.1 percent discussed the genetic test with a health care provider, 13.1 percent were advised to undergo the test and just 10.5 percent had taken it.

Based on those figures, the UCLA researchers estimated that 1.2 million to 1.3 million women in the U.S. who would be most likely to benefit from the test have not taken it.

“Many women are not receiving vital information that can aid with cancer prevention and early detection for them and their family,” said co-author Kimberly Childers, a genetic counselor and regional manager of the Providence Health and Services Southern California’s clinical genetics and genomics program. “Thus, we have identified an incredible unmet need for genetic testing across the country.” 

The paper suggests some reasons that so few women have undergone the test, including that NCCN guidelines have changed over the years, and the relatively small number of board-certified genetic counselors who specialize in cancer testing. (The researchers also note that genetic counselors are unevenly distributed throughout the country, with 500 in California but only five each in Wyoming, Alaska, Missouri and Mississippi.)

“Also, when women change doctors, their new physicians may not be aware of their histories or of the new eligibility guidelines,” said James Macinko, professor of health policy and management and of community health sciences at the Fielding School, and the study’s senior author.

The study has some limitations, including that data was self-reported and not verified by medical records, and that subjects may not have accurately remembered whether they discussed or took the genetic test.

Childers received postdoctoral scholarship funding from the Agency for Healthcare Research and Quality.

Dr. Melinda Maggard-Gibbons, professor of surgery at the Geffen School of Medicine, was a co-author of the study.

Faculty Referenced by this Article

James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
Read Faculty Profile
Mangione, C
Carol Mangione
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Mark Litwin
Health Policy and Management
Read Faculty Profile
Ron D. Hays
Ron D. Hays

@UCLA since 1997

Health Policy and Management
Read Faculty Profile
Dr. Judith M. Siegel
Judith M. Siegel
Community Health Sciences
Read Faculty Profile
Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
Read Faculty Profile
Dr. Michael Prelip
Michael Prelip
Community Health Sciences
Read Faculty Profile
Image of Dr. Susan Ettner
Susan Ettner
Health Policy and Management
Read Faculty Profile
Clifford Ko
Clifford Ko
Health Policy and Management
Read Faculty Profile
Olivia Jung
Olivia Jung
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Brennan Spiegel
Health Policy and Management
Read Faculty Profile
Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Alan Tomines
Health Policy and Management
Read Faculty Profile
Dr. Gilbert Gee
Gilbert C. Gee
Community Health Sciences
Read Faculty Profile
May Wang headshot
May C. Wang
Community Health Sciences
Read Faculty Profile
Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
Read Faculty Profile
Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Jose J. Escarce
Health Policy and Management
Read Faculty Profile
Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
Read Faculty Profile
Galper, Michael
Michael Galper
Health Policy and Management
Read Faculty Profile
Robert Kaplan
Robert Kaplan
Health Policy and Management
Read Faculty Profile
Sean Darling-Hammond
Sean Darling-Hammond
Biostatistics Community Health Sciences
Read Faculty Profile
Dr. Elizabeth Yzquierdo
Elizabeth Yzquierdo
Community Health Sciences
Read Faculty Profile
Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
Read Faculty Profile
Jennifer A. Wagman
Jennifer A. Wagman
Community Health Sciences
Read Faculty Profile
Leah Vriesman
Leah Vriesman
Health Policy and Management
Read Faculty Profile
Burt Cowgill
Burt Cowgill
Health Policy and Management
Read Faculty Profile
Cathy Lang
Cathy Lang

Assistant Dean for Research & Adjunct Associate Professor of Community Health Sciences

Community Health Sciences
Read Faculty Profile
glik, deborah
Deborah Glik
Community Health Sciences
Read Faculty Profile
Charlotte Neumann
Charlotte G. Neumann
Community Health Sciences
Read Faculty Profile
Faculty/staff profile placeholder image
Emmeline Chuang
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Annette Maxwell
Health Policy and Management
Read Faculty Profile
Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Lori Pelliccioni
Health Policy and Management
Read Faculty Profile
Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
David Hayes-Bautista
Health Policy and Management
Read Faculty Profile
Emily Abel
Emily Abel
Health Policy and Management
Read Faculty Profile
Gerald Kominski
Gerald Kominski
Health Policy and Management
Read Faculty Profile
Dr. Kristen Choi
Kristen Choi
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Barbara Berman
Health Policy and Management
Read Faculty Profile
Comanor, Bill
William Comanor
Health Policy and Management
Read Faculty Profile
Nadereh Pourat
Nadereh Pourat
Health Policy and Management
Read Faculty Profile
Dr. Anne Pebley
Anne Pebley
Community Health Sciences
Read Faculty Profile
Laura Erskine
Laura Erskine
Health Policy and Management
Read Faculty Profile
Roshan Bastani Headshot
Roshan Bastani
Health Policy and Management
Read Faculty Profile
Dr. Thomas Rice
Thomas Rice
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Thomas Priselac
Health Policy and Management
Read Faculty Profile
Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
Read Faculty Profile
Philip Massey headshot
Philip Massey
Community Health Sciences
Read Faculty Profile
halbert, ronald
Ronald Halbert
Community Health Sciences
Read Faculty Profile
Kimberly Gregory
Kimberly Gregory
Community Health Sciences
Read Faculty Profile
Michael Ong
Michael Ong
Health Policy and Management
Read Faculty Profile
Dr. Dana Rose Garfin
Dana Rose Garfin
Community Health Sciences
Read Faculty Profile
Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
Read Faculty Profile
Bo-Kyung Elizabeth Kim headshot.png
Bo-Kyung Elizabeth Kim
Community Health Sciences
Read Faculty Profile
Dr. Jessica Gipson
Jessica Gipson
Community Health Sciences
Read Faculty Profile
Diana Hilberman
Diana Hilberman
Health Policy and Management
Read Faculty Profile
Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
Read Faculty Profile
Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
Read Faculty Profile
Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
Read Faculty Profile
Paula Tavrow
Paula Tavrow
Community Health Sciences
Read Faculty Profile
Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Dawn Upchurch
Community Health Sciences
Read Faculty Profile
Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
Read Faculty Profile
Patricia Ganz
Patricia Ganz
Health Policy and Management
Read Faculty Profile
Dr. Michael Goldstein
Michael Goldstein
Community Health Sciences
Read Faculty Profile
Faculty/staff profile placeholder image
Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
Read Faculty Profile
Dr. John Lu
Z. John Lu
Health Policy and Management
Read Faculty Profile
Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
Read Faculty Profile
Avram Kaplan
Avram Kaplan
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Sheba George
Community Health Sciences
Read Faculty Profile
Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
Read Faculty Profile
Dr. Samuel Stratton
Samuel Stratton
Community Health Sciences
Read Faculty Profile
Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
Read Faculty Profile
Virginia C. Li
Virginia C. Li
Community Health Sciences
Read Faculty Profile
Dena Herman
Dena Herman
Community Health Sciences
Read Faculty Profile
Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Robert Brook
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Kimberley Shoaf
Community Health Sciences
Read Faculty Profile
Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
Read Faculty Profile
Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
Read Faculty Profile
Dr. Hiram Beltrán-Sánchez
Hiram Beltrán-Sánchez
Community Health Sciences
Read Faculty Profile
Ilan H. Meyer
Ilan H. Meyer
Community Health Sciences
Read Faculty Profile
Dr. Randall Kuhn
Randall Kuhn
Community Health Sciences
Read Faculty Profile
Moira Inkelas
Moira Inkelas
Health Policy and Management
Read Faculty Profile
Freund, Deborah
Deborah Anne Freund
Health Policy and Management
Read Faculty Profile
Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
Read Faculty Profile
Jack Needleman
Jack Needleman
Health Policy and Management
Read Faculty Profile
Dr. Jennifer Wortham
Jennifer Wortham
Health Policy and Management
Read Faculty Profile
Paul Chung
Paul Chung
Health Policy and Management
Read Faculty Profile
Gordon headshot
Thomas D. Gordon
Health Policy and Management
Read Faculty Profile
Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
Read Faculty Profile
David Eisenman
David Eisenman
Community Health Sciences
Read Faculty Profile
Faculty/staff profile placeholder image
Ondine S. von Ehrenstein
Community Health Sciences Epidemiology
Read Faculty Profile
Dr. Xi Zhu
Xi Zhu
Health Policy and Management
Read Faculty Profile
Dr. Beth Glenn
Beth Glenn
Health Policy and Management
Read Faculty Profile
Dr. Alice Kuo
Alice Kuo
Health Policy and Management
Read Faculty Profile
Dr. Shira Shafir
Shira Shafir
Community Health Sciences Epidemiology
Read Faculty Profile
Dr. Aria Fallah
Aria Fallah
Health Policy and Management
Read Faculty Profile
Balgrosky headshot
Jean Balgrosky
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Neal Halfon
Health Policy and Management
Read Faculty Profile
silhoette
Ty Robbins
Health Policy and Management
Read Faculty Profile
Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
Read Faculty Profile
Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Steven Teutsch
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Natalie Muth
Community Health Sciences
Read Faculty Profile
Vickie Mays
Vickie Mays
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Arlene Fink
Health Policy and Management
Read Faculty Profile
Dana Hunnes
Dana Hunnes
Community Health Sciences
Read Faculty Profile
Dr. Elizabeth D'Amico
Elizabeth D’Amico
Community Health Sciences
Read Faculty Profile
Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
Read Faculty Profile
Davidson - headshop
Pamela Davidson
Health Policy and Management
Read Faculty Profile
Dr. Alina Dorian
Alina Dorian
Community Health Sciences
Read Faculty Profile
Dr. William McCarthy
William J. McCarthy
Health Policy and Management
Read Faculty Profile
Robert Kim-Farley
Robert J. Kim-Farley

Robert J. Kim-Farley, MD, MPH, is a Professor-in-Residence with joint appointments in the Departments of Epidemiology and Community Health Sciences

Community Health Sciences Epidemiology
Read Faculty Profile
Dr. Chandra Ford
Chandra Ford
Community Health Sciences
Read Faculty Profile
Dr. Dylan Roby
Dylan Roby
Health Policy and Management
Read Faculty Profile
Dr. Donald Morisky
Donald E. Morisky
Community Health Sciences
Read Faculty Profile
Dr. May Sudhinaraset
May Sudhinaraset
Community Health Sciences
Read Faculty Profile
Faculty/staff profile placeholder image
Wendelin Slusser
Community Health Sciences
Read Faculty Profile
Dr. Michael Rodriguez
Michael Rodriguez
Community Health Sciences
Read Faculty Profile
Marjorie Kagawa-Singer
Marjorie Kagawa-Singer
Community Health Sciences
Read Faculty Profile
Courtney Thomas Tobin headshot.png
Courtney S. Thomas Tobin
Community Health Sciences
Read Faculty Profile
Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
Read Faculty Profile
Sarah Blenner
Sarah Blenner

Director of Field Studies and Applied Professional Training

Community Health Sciences
Read Faculty Profile
Jeanne Miranda
Jeanne Miranda
Health Policy and Management
Read Faculty Profile