OBJECTIVES : Genetic testing for BRCA1/2 pathogenic variants has been used for targeted, individualized cancer prevention and treatment. Over the past decade, criteria for testing has been loosened. How this has impacted BRCA testing in older women has not been studied. We assessed whether the rate of BRCA testing has changed over time among older women in the United States.

METHODS : This study used de-identified data from a 10% random sample of women ≥65 years old in Optum’s de-identified Integrated Claims-Clinical dataset (2007-2018). A total of 3824 women with BRCA testing results from 2008-2018 were evaluated. Annual percentage change (APC) in BRCA testing and test results were determined. A positive test result indicates a higher risk for developing susceptible cancers (breast or ovarian). Multivariable logistic regression models were used to assess the relationship between positive test results and race/ethnicity, region of residence, income, education, and personal history of breast or ovarian cancer.

RESULTS : Among 3824 women ≥65 years old who underwent BRCA testing from 2008-2018, positive results decreased from 85.7% in 2008 to 55.6% in 2018 (APC -2.55, 95% confidence interval -3.45 to -1.64). Among patients with breast or ovarian cancer, positive results decreased from 83.3% to 61.6%, compared to 88.9% to 48.8% among those without breast or ovarian cancer from 2008-2018 (APC -3.17 vs. -2.49, p=0.29). In 2016-2018, women with positive test results were less likely to have a personal history of breast or ovarian cancer or be living in the Midwest or in areas with high percentage of college graduates. There were no racial/ethnic differences in positive rates of the test results.

CONCLUSIONS : The significantly decreasing positive rate among women ≥65 years old is most likely due to loosening of the criterion for testing. However, socioeconomic and regional disparities in testing utilization remain an issue.