Factors influencing rates of genetic testing in African American Women with heritable gynecologic cancers in a racially diverse academic institution

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<h3>Objectives:</h3> The purpose of this retrospective study is to determine racial and social determinants associated with use of genetic testing for heritable cancer mutations in a high risk, low community resource academic institution population. <h3>Methods:</h3> Women with a personal or family history of heritable cancer (ovarian, fallopian tube, primary peritoneal, breast, colorectal, and endometrial) were identified through the electronic medical record database from August 2015 through August 2019. Demographics (age, sex, race, ethnicity), insurance, and clinical parameters including medical, surgical, social determinants, prior cancer, and family cancer history were evaluated. Patients without a heritable cancer history were excluded.Summary statistics and exact binomial testing were used for comparisons of the rate of genetic testing at the study hospital versus that of reported normative data. To examine whether the internal rates of testing are associated with either demographic or clinical factors, both bivariate and multivariate analyses were performed. For bivariate analyses, chi-square or fisher exact tests for categorical measures and either t-tests or Wilcoxon rank sum tests for continuous measures were used. The effect of the integration of panel testing, which was instituted in August 2017, was determined using a bivariate analysis comparing the groups of patients that were seen before or after August 2017. <h3>Results:</h3> Of the 344 patients analyzed, only 54 (16%) underwent genetic testing, which is significantly lower than the national average (p<0.0003). Race played a significant factor in rates of genetic testing, with African Americans testing at a lower rate than the overall population (p<0.03). Interestingly, insurance type and Hispanic ethnicity did not have an impact on the likelihood of genetic testing. Genetic testing rates were higher in patients with a personal or family history of breast cancer (p<0.015). Notably, although the overall rates of genetic testing increased from 10.3% (95% CI, 6.23 to 16.5) to 18.5% (95% CI, 13.8 to 24.3) after the inclusion of the panel testing, race still played a significant factor in determining the probability of whether testing was performed. <h3>Conclusions:</h3> The findings of this study highlight a lower rate of genetic testing among African American women diagnosed with heritable cancers relative to national recommendations. Our results indicate that despite inclusion of panel testing, racial disparities in rates of testing persist in our vulnerable, high risk population. Interventions to overcome implicit bias and patient education should be further developed.