PIH14 Statewide Trends in Genetic Testing for Hereditary Cancers in Arkansas 2013-2018

Abstract

To study the trends in genetic testing for hereditary breast and ovarian cancers (HBOC), lynch syndrome, and non-specific general genetic tests and receipt of any genetic test for Medicaid, commercial, state employee, and Medicare enrollees in Arkansas. Arkansas All Payers’ Claims Database (APCD) data from 2013 through 2018 was used for commercial, state employee and Medicaid enrollees and due to lags in access 2013-2016 data Medicare recipients. Individuals with at least one month of enrollment with both pharmacy and medical benefits in each quarter were included. Genetic tests were identified using Current Procedural Terminology (CPT-4) codes. Quarterly rates were calculated per 100,000 person-quarters. Age and gender stratified analyses were performed and scatter plots were used to visualize the trends. Time series models using ordinary least squares were estimated to identify trends. There were 1,516,850, 1,501,828, 154,529 and 519,955 individuals in Medicaid, commercial, state employee and Medicare plans respectively. The average age across the total sample was 38, and 54% were female. Across all years, rates of HBOC tests were 2, 22, 40 and 13 per 100,000 person-quarters respectively in Medicaid, commercial, state employee and Medicare. Likewise, the rates of lynch syndrome, general and any genetic tests were: 0.5, 7 and 10 (Medicaid); 2, 21 and 49 (commercial); 6, 77 and 134 (state employee); and 2, 114 and 133 (Medicare) per 100,000 persons-quarters. All measures had increasing linear trends in Medicaid, commercial and state employee (p<0.05), while only tests for HBOC (p=0.020) and lynch syndrome (p=0.004) had significant increasing linear trends in Medicare. HBOC and lynch syndrome test rates were highest among 18–64 females, while general and any genetic test rates were highest among 18–64 males. Genetic tests for hereditary cancers have increased linearly from 2013 to 2018, however the rates of testing to detect cancer remain low.