{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T09:00:41Z","timestamp":1784883641219,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Genetic Counseling"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    In Japan, insurance coverage for\n                    <jats:italic>BRCA<\/jats:italic>\n                    genetic testing was expanded in 2020. The reasons individuals undergo or decline testing remain unclear; however, cost has been identified as a key factor. Herein, we investigated barriers and motivators for undergoing testing. The subjects were 1025 individuals who received genetic counseling at our institution between April 2014 and March 2024. We included 647 patients and 82 blood relatives. We compared the number of patients undergoing tests before and after insurance coverage to evaluate costs. Patients were classified as tested or not tested. Clinical backgrounds and reasons for undergoing or declining testing were compared retrospectively using medical and counseling records. We found that 485 patients underwent testing. There was a significant increase in the number of patients who underwent testing in the 4\u2009years after coverage (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009376) compared with the 6\u2009years before insurance coverage (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009109;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Furthermore, there were significant differences in insurance\/self\u2010pay, treatment status (preoperative\/during treatment), and age at first counseling. The main reasons for declining testing were \u201cDiscuss options with relatives\u201d (28%) and \u201cFocused on current treatment\u201d (14.3%). Cost\u2010related concerns markedly decreased after insurance coverage, suggesting cost had been an important structural barrier. Motivators for testing included \u201cDetermine the surgical technique\u201d (42.7%) and \u201cFor my health care\u201d (22.3%). The blood relative testing rate was high at 91% (75\/82). In addition to our finding that cost had been an important barrier to testing, we identified several other non\u2010medical barriers. In Japan, the selection of candidates for testing and clinical indications are determined according to Japanese HBOC clinical guidelines. We identified determination of the surgical technique as the main motivator, as well as the timing of counseling being important. Understanding barriers and motivators could help clients who need testing.\n                  <\/jats:p>","DOI":"10.1002\/jgc4.70181","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T05:40:50Z","timestamp":1771220450000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and motivators for\n                    <scp>\n                      <i>BRCA<\/i>\n                    <\/scp>\n                    genetic testing in Japan"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2606-2950","authenticated-orcid":false,"given":"Katsuyuki","family":"Konnai","sequence":"first","affiliation":[{"name":"Department of Gynecology Kanagawa Cancer Center  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8888-9937","authenticated-orcid":false,"given":"Hiroyuki","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2660-9028","authenticated-orcid":false,"given":"Eri","family":"Haneda","sequence":"additional","affiliation":[{"name":"Department of Genetic Medicine Kanagawa Cancer Center  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5572-3893","authenticated-orcid":false,"given":"Ann","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Genetic Medicine Kanagawa Cancer Center  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2770-1731","authenticated-orcid":false,"given":"Haruya","family":"Saji","sequence":"additional","affiliation":[{"name":"Department of Gynecology Kanagawa Cancer Center  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0383-4911","authenticated-orcid":false,"given":"Hiroto","family":"Narimatsu","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Division Kanagawa Cancer Center Research Institute  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-63300-8"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/298745"},{"key":"e_1_2_14_4_1","first-page":"1251","article-title":"Factors associated with decisions about clinical BRCA1\/2 testing","volume":"9","author":"Armstrong K.","year":"2000","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.1066"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-015-3374-7"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2016.29"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1237"},{"key":"e_1_2_14_9_1","first-page":"267","article-title":"Barriers to genetic testing for breast cancer risk among ethnic minority women: An exploratory study","volume":"22","author":"Glenn B. A.","year":"2012","journal-title":"Ethnicity & Disease"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/gte.2006.9998"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897-016-0064-5"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16101865"},{"key":"e_1_2_14_13_1","volume-title":"Guidelines for diagnosis and treatment of hereditary breast and ovarian cancer 2024 [in Japanese]","author":"Japanese Organization of Hereditary Breast and Ovarian Cancer","year":"2024"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12935-021-02194-2"},{"key":"e_1_2_14_15_1","first-page":"173","article-title":"Investigation of the actual conditions of clinical approach to hereditary breast and ovarian cancer syndrome in order to standardize genetic medical systems in Japan [in Japanese]","volume":"40","author":"Komine M.","year":"2019","journal-title":"Japanese Journal of Genetic Counseling"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-023-01048-9"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.7112"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4627"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz009"},{"key":"e_1_2_14_20_1","first-page":"35","article-title":"Decision not to take genetic testing among people of hereditary cancers [in Japanese]","volume":"12","author":"Nakata H.","year":"2012","journal-title":"Journal of Hereditary Tumors"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000441714"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2009.07.003"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s44276-024-00099-x"},{"key":"e_1_2_14_24_1","first-page":"79","article-title":"Health insurance and discrimination concerns and BRCA1\/2 testing in a clinic population","volume":"11","author":"Peterson E. 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S.","year":"2002","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2018.09.011"}],"container-title":["Journal of Genetic Counseling"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgc4.70181","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jgc4.70181","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgc4.70181","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T08:02:37Z","timestamp":1784880157000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgc4.70181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/jgc4.70181"],"URL":"https:\/\/doi.org\/10.1002\/jgc4.70181","archive":["Portico"],"relation":{},"ISSN":["1059-7700","1573-3599"],"issn-type":[{"value":"1059-7700","type":"print"},{"value":"1573-3599","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-10-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70181"}}