Introduction
germline BRCA, breast cancer, HER2-negative, Germline BRCA, HRR) deficiency, TNBC, a deficiency, breast tumours, primary ovarian cancers
DISEASE PROGRESSION, METASTASIS, RECURRENCE, BREAST CANCER, NA DEFICIENCY, SECONDARY, BREAST, BREAST TUMOURS
Germline BRCA (gBRCA) 1/2 pathogenic or likely pathogenic variants (P/PVs) tend to cause homologous recombination repair (HRR) deficiency in breast cancer (BC) patients, which may significantly expedite disease progression, leading to primary ovarian cancers, secondary contralateral BCs, locoregional recurrence and even distant metastasis [Poly-(ADP)-ribose polymerase (PARP) inhibition is synthetically lethal with a deficiency in HRR; therefore, PARP inhibitors (PARPi) are regarded as a promising approach for treating BRCA1/2-mutated BCs [To date, the American Society of Breast Surgeons recommends that germline BRCA testing is indicated for all newly diagnosed breast cancer patients [Due to the decreased cost of gBRCA testing and the promising efficacy of olaparib therapy to improve survival in patients with breast cancer and BRCA1/2 PVs, it is essential to examine whether gBRCA testing is appropriate for all patients with TNBC and HR-positive HER2-negative breast tumours [In this study, we designed a cost-effectiveness analysis based on clinical data and compared three gBRCA testing strategies in all TNBC and HR-positive HER2-negative BC patients: (1) no gBRCA testing (no test); (2) selected gBRCA testing based on family history and genetic consultations (selected test) and (3) universal gBRCA testing for all TNBC and HR-positive HER2-negative BC patients (universal test). The analysis was performed explicitly based on China and the USA. The present study aimed to address the cost-effectiveness of BRCA-associated treatment (adjuvant olaparib and RRO) secondary to gBRCA testing in TNBC and all HER2-negative BC (inclusive of TNBC) patients under different scenarios in China and the USA.