OBJECTIVES: To identify the demographic, geographic, clinical, and health system factors associated with the use of mastectomy and salpingo-oophorectomy for cancer prevention among persons diagnosed with hereditary susceptibility to breast and ovarian cancer.

METHODS: Claims records from January 2013 through June 2018 (commercial, state employee and Medicaid), or December 2016 (Medicare) from the Arkansas All-Payer Claims Database were used to identify enrollees with genetic susceptibility to breast and ovarian cancer. The index date was the first claim with a diagnosis of genetic susceptibility to cancer. Individuals with ≥180 days of continuous enrollment for both pharmacy and medical benefits before and 1 day after the index date were analyzed. Enrollees were followed until preventive surgery, study end date or loss of enrollment. Covariates were assessed in the 180-day pre-index period. Cox Proportional Hazards models were estimated to identify factors associated with receipt of cancer prevention surgery.

RESULTS: There were 836 individuals in the breast cancer naïve cohort and 266 in the ovarian cancer naïve cohort. Among breast cancer naïve enrollees, 97 (11.60%) underwent mastectomy and 80 (9.57%) underwent salpingo-oophorectomy. Age was the only factor associated with salpingo-oophorectomy (HR=0.81; 95%CI:0.67-0.97), while Medicare coverage (HR=0.23; 95%CI:0.09-0.61) and geographical region were associated with mastectomy. Among ovarian cancer naïve patients, 42 (15.79%) underwent mastectomy and 99 (37.22%) underwent salpingo-oophorectomy. Age was the only factor associated with mastectomy (HR=0.66; 95%CI:0.49-0.90), while prior breast cancer diagnosis (HR=2.22; 95%CI:1.40-3.53) and year of genetic susceptibility to ovarian cancer were associated with salpingo-oophorectomy.

CONCLUSIONS: Roughly 10% of enrollees with genetic susceptibility to cancer who were breast cancer naïve underwent mastectomy or salpingo-oophorectomy, while those who were ovarian cancer naïve more often underwent mastectomy (16%) or salpingo-oophorectomy (37%). Younger women diagnosed with genetic cancer susceptibility were more likely to undergo cancer prevention surgery than their older counterparts.