Presentation (CTI)

OBJECTIVES: BRCA1/2 mutations confer a substantial lifetime risk of breast cancer (50-80%) and ovarian cancer (20-40%). Israel’s national BRCA screening program, implemented in 2020, provides free screening for women aged ≥25 years. This initiative has driven a tenfold increase in testing and a corresponding rise in carrier identification, which has translated into markedly greater utilization of healthcare services. These include intensified oncologic surveillance, annual imaging with MRI and mammography, comprehensive genetic and oncologic counseling, prophylactic surgical interventions (mastectomy and oophorectomy), and psychological support.
The aim of this study is to evaluate changes in healthcare resource utilization (HRU) and expenditures among BRCA carriers versus non-carriers.
METHODS: Every BRCA positive woman (n=189) was matched to up to 10 non-carrier women (n=1,879) on socioeconomic status, demographic sector, district, birth year, and the screening test year. The delta between HRU and expenditures during the post-test year and the pre-test year were compared between the groups. Negative binomial regressions and two-part regression models were conducted to assess the difference-in-difference (DiD) between the groups on HRU and expenditures.
RESULTS: Analysis of HRU and expenditures revealed significant differences between BRCA carriers and non-carriers. Surgical expenditures doubled (DiD ratio 2.04 95% CI 1.13-1.36)), primary care expenditures rose by 17% (DiD ratio 1.17 95% CI 1.06-1.29) and specialist consultancy expenditures rose by 24% (DiD ratio 1.24 95%CI 1.13-1.36) for BRCA carrier vs. non-carrier women. Hormone replacement therapy usage increased nearly fivefold, and gynecological visits rose by about 40%, while the non-carrier group showed slight declines in these categories.
CONCLUSIONS: These findings show significant elevated healthcare utilization among women identified as BRCA carrier women following screening.