Genetic testing in cancer care: An assessment of current practice in Africa.
Authors: Ajose Azeezat Oluwafunmilayo , Graef Katy , Mallum Abba Aji , Oladipo Aishat , Ibrahim Fatoumata , Li Heng , Lehmann Joerg , Awusi Kavuma , Incrocci Luca , Huq M. Saiful , Tendwa Marueen Bilinga , Bhatia Rohini , Adeneye Samuel Olaolu , Kibudde Solomon , Avery Stephen , Mkhize Thokozani , Ngoma Twalib Athumani , Ngwa Wil , Swanson William , Joseph Adedayo 
Published: July 2024

e13784

Background: Genetic testing provides forprecision oncologic intervention, improving outcomes and minimizing traditional cytotoxicity. It has caused a dramatic change in the oncology landscape but remains underutilized in Africa. Data on genetic alterations associated with cancer in people of African descent continue to be inadequate due to multi-layered factors such as availability and cost of testing, provider awareness and knowledge, and availability and cost of targeted therapy. With cancer projected to be the leading cause of mortality in Africa within the next two decades, identifying the current patterns of testing and reasons for low uptake is crucial for developing strategies to improve cancer care and outcomes in Africa. This study aimed to map the current utilization pattern of cancer genetic testing among oncologists in Africa. Methods: An online cross-sectional survey was administered to oncologists practicing in Africa. Responses were collected between September 2023 and January 2024 following IRB approval from the Lagos University Teaching Hospital Health Research and Ethics Committee. Surveys were administered in English and French. Results: 245 oncologists across 28 African countries participated in this study. The mean age of respondents was 41.6 (SD: 8.3), with 64.5% being male and Nigerians comprising the largest proportion (33.0%). The majority of respondents practice in public/government-owned facilities (44.1%), and 64.5% held consultant/attending positions. Survey findings showed that 69.8% of oncologists lacked confidence in understanding/interpreting genetic test results, 93.5% expressed the need for assistance in interpreting results, and 64.1% were unable to discuss findings confidently with patients. The most ordered test was BRCA1/2 (47.3%), while ABC and RB1 genes were the least commonly ordered (0.008% and 0.02%, respectively). The primary reason for ordering genetic tests (63.3%) was the potential to guide treatment planning. However, 54.7% reported not referring any patients for genetic testing in the past year. Barriers to testing included the high cost of tests (78%) and targeted therapies (60.4%). Furthermore, 67.8% of respondents lacked previous formal training in cancer genetics with nearly all respondents (97.6%) expressing interest in formal training and a preference for online courses (71.8%). Conclusions: This survey highlights the critical need to develop the capacity for understanding cancer genetic testing and targeted treatment options among oncologists in Africa. To optimize uptake, strategies must be developed to reduce testing costs through resource pooling and to reduce the high cost of targeted treatment. Oncologists should be encouraged to prioritize testing that guides actionable targets to promote the uptake of targeted treatment options in Africa.