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Narrative review finds BRCA testing increased 7%-47% but gaps remain in breast cancerBreast Cancer Gene Testing Grows, But Gaps Remain for Some Patients

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Key Takeaway
Recognize that BRCA testing increased 7%-47% over time but gaps persist, especially in hormone receptor-positive early breast cancer.

This targeted literature review synthesizes evidence from 35 publications representing 32 unique studies on germline BRCA (gBRCAm) testing patterns among patients with breast cancer in the United States. The review focuses on testing rates over time, barriers to testing, and patient knowledge, beliefs, and attitudes.

Key findings include a 7%-47% increase in BRCA testing over time, though the range reflects variations across studies. The authors highlight an unmet need for improved testing, particularly for eligible patients with hormone receptor-positive early breast cancer. Other outcomes examined include barriers to testing and misconceptions, but no pooled effect sizes are reported.

Limitations noted by the authors include that the majority of studies had data collection periods prior to 2020, and there were variations due to differing study designs, populations, and assessment periods. The review does not report on specific adverse events or funding sources.

Clinically, the findings suggest that while BRCA testing has increased, gaps remain, especially in certain subgroups. Further evaluation of recent testing trends and barriers is needed to inform practice improvements.

A targeted literature review examined how often patients with breast cancer in the United States are tested for germline mutations in breast cancer genes. Researchers looked at 35 publications that represented 32 unique studies to understand testing patterns, barriers, and patient knowledge. Most of the data collected in these studies occurred before 2020, which limits how well it reflects current practices.

The analysis found that testing rates increased significantly over time, with gains ranging from 7% to 47%. Despite this progress, the review highlighted a persistent unmet need for improved testing. This gap is particularly evident among eligible patients who have hormone receptor-positive early breast cancer. These patients may not be receiving the genetic testing they qualify for.

Because the evidence comes from a review of older studies with varying designs, readers should be cautious about applying these findings directly to today's clinics. The authors suggest that further evaluation is needed to understand recent testing trends and the barriers that still exist. Patients and providers should recognize that while testing is becoming more common, access is not yet equal for everyone.

What this means for you:
BRCA testing rates are rising, but eligible patients with hormone-positive early breast cancer still face barriers to access.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Testing for germline mutations in breast cancer genes (gBRCAm) is recommended to inform treatment decisions for patients with breast cancer (BC); however, not all eligible patients will undergo testing. This targeted literature review summarizes evidence on real-world patterns of gBRCAm testing in BC in the United States (US) and misconceptions, beliefs, attitudes, or barriers related to gBRCAm testing. A total of 35 publications published up to September 2024 were included in the review, representing 32 unique studies. Since the early 2000’s, studies consistently reported increases in BRCA testing over time (7%-47% increase, with variations based on differing study designs, populations, and assessment periods). However, an unmet need for improved testing remains, particularly for eligible patients with hormone receptor-positive early BC. Barriers to testing reported by patients and physicians include lack of clear guidelines around gBRCAm testing eligibility, high costs, and inadequate insurance coverage. Additionally, patients with BC often reported limited knowledge regarding gBRCAm testing. Variable access to genetic counseling was reported by physicians as both a driver and a barrier to testing, and some physicians lack the expertise or confidence to discuss testing results with patients. Further evaluation on recent gBRCAm testing trends and barriers related to BRCA testing in the US is needed as the majority of studies identified in this literature review had data collection periods that occurred prior to 2020.
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