Mandating the use of a genetic counselor lowered access to appropriate testing but did not seem to decrease inappropriate testing in a study involving a health plan that instituted such a policy.

Investigators compared test cancellation rates, mutation-positive rates, and turnaround times for comprehensive BRCA1/2 testing both before and after the policy change. They also looked at a control group that was not subject to the change. Among the results:

• Cancellation rate increased from 13% before the policy change to 42% afterwards.
• Cancellation rate increase was also seen in those who met NCCN criteria for testing; the rate went from 10% to 38%.
• Cancellation rates rose across all ethnicities, but increased more so in blacks and Hispanics (to ~50% in both groups).
• The rate increased to 34% in whites.
• Cancellation rates decreased or stayed the same for all control participants.