Factors associated with delayed genetic testing for patients with BRCA-related cancers (428)

Abstract

<b>Objectives:</b> NCCN recommends testing for <i>BRCA</i> based on personal and family history of cancer and known mutations. However, there have been disparities in access to and uptake of genetic testing. The objective of this study was to determine factors associated with delayed genetic testing for those meeting NCCN criteria with <i>BRCA</i>- related cancers (BRC). <b>Methods:</b> This was a retrospective cohort study at three sites within one institution from 2014 to 2018. Patients with <i>BRCA1</i> and <i>BRCA2</i> pathogenic mutations were identified by ICD-10 codes associated with the hereditary disposition of malignancy. Patients were included if they had <i>BRCA</i>-related cancer, known dates of genetic testing, and dates of cancer diagnoses. NCCN testing criteria were applied to all patients to determine if they met the criteria for testing before a BRC diagnosis. Outcomes of interest were the factors associated with undergoing <i>BRCA</i> testing after a cancer diagnosis. Chi-square, Mann- Whitney U test, and univariate and multivariate logistic regression analyses were performed with significance at p<0.05. <b>Results:</b> Of 281 patients with a personal history of a BRC, 88 (31%) underwent testing before a BRC diagnosis, and 193 (69%) underwent genetic testing after the diagnosis. The median age of cancer diagnosis was 44 versus 47.5 years, respectively (p=0.082). Compared to patients undergoing genetic testing before a BRC diagnosis, patients who underwent genetic testing after their BRC diagnosis were older at the time of testing (45 vs 50 years, p=0.022). Non-white patients were more likely to undergo genetic testing after a BRC diagnosis compared to white patients (42 of 52, 80% vs 151 of 229, 66%, p=0.037). Patients with non-private insurance (Medicaid/Medicare, uninsured) were also more likely to be tested after a BRC diagnosis compared to privately insured patients (70 of 89, 79% vs 123 of 192, 64%, p=0.014). Patients with no known family history of known mutation were more likely to be tested after a BRC diagnosis compared to patients with a known mutation history (144/188, 76% 49/93, 53%, p<0.001). Factors associated with undergoing genetic testing after a cancer diagnosis when controlling for race, county of residence, history of breast and ovarian cancers were private insurance (OR: 2.16, 95% CI: 1.12-4.18) and no history of family mutations (OR: 3.18, 95% CI: 1.16-5.75). Table 1 <b>Conclusions:</b> NCCN criteria for genetic testing allow for early diagnosis and prevention of BRC. Almost 80% of publicly insured and uninsured patients underwent genetic testing after a cancer diagnosis and were twice as likely to be tested after a cancer diagnosis when compared to privately insured patients. Significant disparities exist in access to early genetic testing based on insurance status.