Hereditary cancer screening at an urban safety net hospital

• Published in: Journal of clinical oncology Vol. 40; no. 16_suppl; p. 10604
• Main Authors: Brehany, Sydney, Colton, Meryl D., Duarte, Cassandra, Baliton, Michael, Okuyama Sasaki, Sonia
• Format: Journal Article
• Language: English
• Published: American Society of Clinical Oncology 01.06.2022
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2022.40.16_suppl.10604

10604Background: Individuals with hereditary cancer syndromes (HCS) have a high lifetime risk of developing cancer. However, the rate at which at-risk individuals undergo genetic evaluation is low, particularly for individuals that belong to populations that are historically underserved. We sought to characterize the demographic factors that may be associated with receipt of recommended HCS evaluation and follow-up. Methods: All patients with pathologically confirmed breast, ovarian, or fallopian tube cancers and qualifying for hereditary breast and ovarian cancer (HBOC) testing based on NCCN guidelines from 2016 to 2021 at an urban safety-net hospital were included in this analysis. Institutional review board approval was obtained. Demographic and oncologic data, as well as HBOC genetic testing outcomes were collected through retrospective chart review using a standardized data collection tool. Univariate logistic regression models were constructed to test the association of variables with receiving hereditary cancer genetic testing. Results: A total of 312 patients were included in the analysis, 90% of which had breast cancer. Forty percent were non-English speaking, 31% were non-White, and 25% were uninsured. Overall, 70% of patients were referred for genetic counseling and 65% underwent testing. Our analysis showed higher association of genetic testing uptake with Spanish language [odds ratio (95% confidence interval)] [1.74 (1.04, 2.93)], stage II disease [2.15 (1.11, 4.16)], and having a referral to genetic counseling [9.21 (5.32, 15.96)]. A lower rate of genetic testing was associated with patients identifying as Black [0.36 (1.87, 0.70)], having Medicare insurance [0.29 (0.14, 0.61)], a higher Charlson Comorbidity Index [0.31 (0.13, 0.73)], and older age [0.94 (0.92, 0.96)]. Uninsured patients had a similar association with genetic testing uptake as patients with Medicaid. Variables seeming to have no association with genetic testing uptake include family history of cancer, type of cancer, performance status, substance use, and Latinx ethnicity. A pathologic variant was found in 13% of our population. A variant of unknown significance (VUS) was found in 33% of Hispanic or Latinx patients and in 46% of non-Hispanic or Latinx patients who received testing, for a combined VUS prevalence of 39%. Conclusions: Our analysis shows that genetic testing rates for patients meeting HBOC syndrome criteria at an urban, safety-net institution were higher than expected, particularly for Spanish speaking patients and those with Medicaid or no insurance. We hypothesize this may be due to the emphasis our institution places on the care of uninsured patients through programs to make services accessible, as well as strong engagement with the Spanish speaking community. These results can help guide future interventions to target patient groups with lower rates of genetic testing, as well as maintain the successes seen among our diverse population.