Genetic Testing for Breast and Ovarian Cancer

Genetic testing for breast and ovarian cancer has been publicly available since the mid-1990 discovery of two breast/ovarian cancer susceptibility genes named BRCA1 and BRCA2. Although many professionals say that genetic testing may be the best available preventative medicine breakthrough, controversy abounds over whether the medical benefits of BRCA1/2 mutation testing outweigh the psychological and financial costs. This study uses three models to analyze 104 women’s responses to a self-designed questionnaire: a logit regression model, an ordered probit regression model, and a cost effectiveness model. The regression models use questionnaire responses to learn how the benefits and costs of genetic testing affect a woman’s decision to get genetically tested for breast/ovarian cancer susceptibility at price points that correspond to no insurance, 20% coinsurance, and full insurance. The cost effectiveness model determines for whom BRCA1/2 mutation testing is cost effective by evaluating average and individual utilities for post-genetic test treatment strategies. The results of this study indicate that women’s level of risk and the price of the BRCA1/2 mutation test affect women’s responsiveness to testing. Overall, as price decreases, more women who should not be genetically tested (from a social cost effectiveness perspective) want to get tested. In addition, women’s preferences for post-genetic test treatment options matter in determing women’s cost effectiveness of testing. In fact, customizing cost effectiveness by individual preferences (in contrast to using average utilities for post-test surgeries) makes BRCA1/2 mutation testing cost effective for more women. By evaluating how well the normative cost effectiveness model and descriptive regression models match up, this study ultimately determines that genetic testing for breast/ovarian cancer susceptibility is being underdone when patients pay the full cost or 20% of