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BRCA Genetic Mutation Testing for Breast and Ovarian Cancer Susceptibility

Revised: 10-19-2016

Authorization Criteria

BRCA genetic mutation testing for breast and ovarian cancer in women will be approved in cases where the results will impact the care of the patient.

The patient must meet criteria in either 1 or 2:

  • 1. Patient is identified as high-risk for a BRCA mutation and is one of the following:
  • • Is of Ashkenazi Jewish descent with breast or ovarian cancer. This includes any first-degree relative (or two second-degree relatives on the same side of the family)*. This also includes any other ethnicity or population for which “founder” mutations in the BRCA genes have been identified.
  • • Is of an ethnicity that is not Ashkenazi Jewish and has one or more of the following:
  • • Two first-degree relatives with breast cancer, one of whom was diagnosed at age 50 or younger
  • • A combination of three or more first or second-degree relatives with breast cancer regardless of age of diagnosis
  • • Any combination of breast and ovarian cancer among any combination of first and second-degree relatives
  • • A first-degree relative with bilateral breast cancer
  • • A combination of two or more first or second-degree relatives with ovarian cancer, regardless of age of diagnosis
  • • A first or second-degree relative with both breast and ovarian cancer at any age
  • • History of breast cancer in a male relative
  • 2. Patient has personal history of breast or ovarian cancer and wishes to inform future reproductive decision-making.
  • *A first-degree relative is a person’s parent, sibling, or child. A second-degree relative is a person’s aunt, uncle, grandparent, grandchild, niece, nephew, or half-sibling.

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