OBJECTIVES : Predictive BRCA1 & BRCA2 testing describes testing in an asymptomatic person to predict future risk of disease after a mutation has been found in a family relative. Relatives can sequentially have their DNA tested for that variant alone. Following the publication of Angelina Jolie’s editorial ‘My Medical Choice’ in the New York Times on the 14th May 2013 and NICE clinical guidelines (CG164) on the 25th June 2013, BRCA testing received much publicity. Therefore, we examined trends in testing and time from proband testing to testing in relatives.

METHODS : A database was collated using routinely collected hospital data from an area covered by Cheshire and Merseyside Regional Genetic Service in the UK. 779 people received predictive BRCA testing. A segmented linear regression model was used to estimate changes in the trend of predictive BRCA testing following the publication of both the Jolie editorial and NICE guideline. Regression coefficients were used to calculate average change in rates, adjusted for prior level and trend. A Cox proportional hazards model was used to evaluate factors associated with time to predictive BRCA testing.

RESULTS : The month following the Jolie editorial and NICE guideline publication, predictive BRCA testing increased by 64.3% (P=0.003). Between April 2010 and March 2017, testing increased four-fold from 0.14 to 0.61 tests/100,000 per month. Relatives of probands tested for BRCA2 were likely to receive testing in less time than BRCA1 (<0.001). Further, relatives aged >40 years were likely to receive BRCA testing in less time (<0.001). This age disparity may exist as younger populations were more likely to be eligible for testing via second- or third-degree relatives, but it was not possible to adjust for this confounder.

CONCLUSIONS : Predictive BRCA testing uptake increased following the Jolie editorial and NICE guideline publication, but further work on disparities in predictive BRCA testing rates is needed.