Breaking Barriers: Enhancing Access to Genetic Testing for All Breast Cancer (BC) Patients

Document Type

Conference Proceeding

Publication Date

3-11-2025

Publication Title

Ann Surg Oncol

Keywords

adult, aged, breast cancer, Caucasian, cohort analysis, conference abstract, consultation, controlled study, counselor, diagnosis, female, genetic counseling, genetic screening, human, major clinical study, minority group, patient referral, race

Abstract

Revised genetic testing guidelines in 2019 recommended that all BC patients be eligible for testing. Our institution historically required a referral to a genetic counselor to have testing ordered. The 2019 guideline revision resulted in a larger number of patients referred, overwhelming our genetic counselling capacity. Further, there is a known disparity in minority population genetic testing and our metropolitan Detroit patient population has a significant proportion represented by black women (BW). Efforts were thus made in 2023 to improve access and testing rates by implementing an internal comprehensive genetic panel allowing cancer providers to directly order genetic testing. This study aims to define the rate of genetic testing before and after 2023, to assess the impact of these changes on testing completion rates and identify potential barriers to successful testing. METHODS: We used our institutional IRB-approved prospective BC registry to evaluate patients who were recommended for genetic testing from 2017 to 2024. Collected data points included patient race, genetic counselor referral, completion of consultation, and completion of genetic testing. RESULTS: Between 2017 and 2024, there were 2,437 women who consented to our registry, 1,656 were referred for genetic testing. Genetic referrals increased from 2017-2019 to 2020-2022 (61% to 72%, p< 0.0001). Genetic consultation completion also increased from 2017-2019 to 2020-2022 (76% to 86%, p< 0.0001). Analysis of 2017-2019, 2020-2022, and 2023-2024 patients showed a significant increase in completion of testing in the 2023-2024 cohort - 64% in 2017-2019, 60% in 2020-2022, 78% in 2023-2024 (p<0.0001). Univariate analysis by race between Caucasian women (CW, n=1029) and black women (BW, n=502) compared 2017-2022 and 2023-2024. Both groups significantly increased testing completion rates - 65% in 2017-2022 compared to 82% in 2023-2024 for CW (p<0.001) and 56% in 2017-2022 compared to 74% in 2023-2024 (p=0.01 ). BW had higher rates of not completing genetic consultation compared to CW (26% vs 18%), however this was not significant (p=0.21 ). CONCLUSIONS: Since the guidelines for genetic testing in patients with BC changed in 2019, we found a significant increase in the genetics counseling referral rate at our institution. However, providing direct access to panel testing in 2023 significantly improved completion of testing across all patients. Although not significant, the discrepancy trend toward testing completion for BW is worth noting and a second target for improvement.

Volume

31

First Page

S179

Last Page

S180

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