OBJECTIVE: The aim of our study was to determine the rate of participation in 
genetic testing, to determine the reasons for non-participation and to identify 
the factors affecting participation in BRCA genetic testing for high-risk 
patients.
METHODS: This study was performed through a retrospective review of 804 
individuals who underwent genetic counseling for BRCA1/2 gene mutations at Seoul 
National University Bundang Hospital between July 2003 and September 2012.
RESULTS: In total, 728 (90.5%) individuals underwent BRCA1/2 mutation screening 
after the initial genetic counseling; 88.2% of 647 probands and 100% of 157 
family members were screened. In multivariate analysis, family history of breast 
cancer and younger age were independent variables affecting participation in 
genetic testing. Of the 132 people who initially declined genetic testing, 58 
(43.9%) postponed the decision, 30 (22.7%) needed time to discuss the issue with 
family members, 22 (16.7%) did not want to know if they had a BRCA1/2 mutation, 
and 22 (16.7%) declined the test because of financial problems. When analyzing 
refusal of testing according to the time period before and after the 
implementation of national health insurance coverage for BRCA1/2 genetic 
testing, the critical reason given for refusal was different. After insurance 
coverage, refusal for financial reason was decreased from 61.1 to 9.6%.
CONCLUSIONS: A family history of breast cancer and a younger age were important 
factors associated with participation in genetic testing. National health 
insurance decreased the proportion of individuals who did not participate in 
testing owing to a financial reason. In genetic counseling, we have to 
understand these issues and consider several factors that may influence an 
individual's decision to be tested.