Current Policy Priority

FORCE Provides Input on BRCA Screening Research Plan

February 2024 - U.S. Preventive Services Task Force (USPSTF) recommendations guide the use of many health screenings and determine which preventive services are available to patients at no cost under the Affordable Care Act (ACA). FORCE submitted comments in response to the recently published USPSTF draft BRCA screening research plan. Once finalized, the latest studies will be analyzed and the guidelines will be updated accordingly.

Typically reviewed and updated every 5-7 years, the Task Force published its current guidelines for “BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing” in September 2019. At that time, the USPSTF slightly expanded the population eligible for BRCA counseling and testing but we believe the recommendations are significantly lacking. FORCE comments on the draft research plan for updated guidelines note that the proposed scope of the recommendations continues to fall short of meeting the needs of Americans who may be at increased risk of cancer due to hereditary factors. 

Included Populations
The proposed research plan fails to include key populations including men, women with a personal or family history of cancers other than breast or ovarian, and patients currently in cancer treatment. There is a relationship between inherited genetic mutations such as BRCA and cancers including prostate, pancreatic, male breast and colorectal. A substantial portion of people with mutations that increase their risk of cancer are missed with the narrow population under consideration.

Mutations Beyond BRCA
The proposed research plan is limited to risk for BRCA1 and BRCA2 mutations. This fails to acknowledge that mutations in genes including ATM, BARD1, CDH1, CHEK2, MLH1, MSH2, PALB2, PTEN, TP53 and STK11 increase the risk of breast and/or ovarian as well as other cancers. For this reason, the current standard of care is multigene panel testing. The USPSTF must consider genetic mutations beyond BRCA1/2 to adequately address cancer risk and mortality. See our article on the development of USPSTF of Lynch Syndrome Screening Guidelines for related information.

Screenings & Interventions
The research and related recommendations should include interventions pertinent to the early detection of all cancers related to hereditary cancer mutations. In addition, the guideline letter grade should apply to the associated preventive screenings and risk-reducing surgeries for mutation carriers. Without this, medically necessary downstream services such as breast screening MRIs, colonoscopies before age 45, and risk-reducing surgeries may not be adequately covered by insurers. These interventions constitute "prevention" and should be included in the USPSTF recommendation to facilitate affordable access.

Timeline and Next Steps
After considering the draft research plan feedback, the USPSTF will finalize its research plan. Using this as a guide, the Task Force will develop and share draft recommendations on its website. Once again, there is a public comment period. The USPSTF will review the comments and make any changes it deems are needed. Then, the final recommendation statement, evidence review and evidence summary are posted on its website. This process may take up to two years. FORCE will weigh in every step of the way.