2023 ACMG Annual Clinical Genetics Meeting Digital Edition: Poster Gallery-Increasing Equitable Access and Uptake for Hereditary Cancer Testing in Patients with Breast Cancer

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The Persistent underuse of testing for hereditary cancer risk in breast cancer patients is a missed opportunity for quality care and prevention. Barriers at the health system, provider, and patient levels contribute to low rates of uptake, particularly in underserved and minority patients. To address this issue, the UNC Cancer Genetics Clinic partnered with the UNC Breast Surgery/Oncology clinic in April 2021 to establish a point of care (POC) genetic testing process. This model enables oncology providers to discuss and order genetic testing with support from Genetic specialists for patient identification, test selection, and post-test interpretation. Unlike traditional pre-test genetic counseling, Genetics provides post-test consultation for patients with diagnostic variants on their test results. Pre-curated genetic tests and order sets based on NCCN guidelines are utilized, along with eConsults for low-cost specialty input on test interpretation and management recommendations. <br /><br />Up to one-third of breast cancer patients may meet hereditary testing criteria, but only 10% of those tested are estimated to have a diagnostic result. The POC model aims to minimize the burden on patients and streamline genetic assessment for all patients. The majority of patients receive normal results, while those with positive results can receive timely consultation within 1-5 days. Disparities in genetic testing have been well documented, but this program demonstrates equitable completion rates among all racial groups. The next steps include improving the use of embedded risk algorithms and order sets, developing quality improvement reports and patient education materials, and expanding the program to additional cancer clinic settings. <br /><br />The program has completed 191 STAT Breast Gene tests, with 175 eConsults completed. The institutional data suggests equitable access across racial groups, with 62% of White patients and 26% of Black patients completing recommended testing. The program aims to continue tracking progress and integrating genetic test results into the electronic health record system. Overall, the Genetics Supported Point-of-Care Testing + eConsult program offers timely and equitable access to hereditary cancer testing for breast cancer patients, aiming to reduce disparities in cancer care and optimize the use of genetics services.

Asset Subtitle

Presenting Author - Julianne M. O'Daniel, MS; Co-Author - Christine E. Kobelka, MSc, CGC, CCGC; Co-Author - Daniella Escobar, BS;

Meta Tag

Cancer Syndromes

Counseling

Ethical Legal and Social Issues

Genetic Testing

Risk Assessment

Co-Author Christine E. Kobelka, MSc, CGC, CCGC

Co-Author Daniella Escobar, BS

Presenting Author Julianne M. O'Daniel, MS

Keywords

testing

hereditary cancer risk

breast cancer patients

quality care

prevention

health system

provider

underserved

minority patients

genetic testing