Abstract 2427: Patterns of BRCA testing by provider type based on biological and non-biological factors among a diverse sample of young breast cancer survivors
Authors: Reid Sonya , Cragun Deborah , Tezak Ann , Weidner Anne , Mayer Ingrid , Shu Xiao-ou , Vadaparampil Susan , Pal Tuya 
Published: August 2019

Introduction: Per national practice guidelines, pre-test genetic counseling through a provider experienced and proficient in genetics (such as a genetics health professional (GHP)) is recommended prior to genetic testing for hereditary cancer. We sought to determine if there are differences in clinical and demographic variables between young breast cancer (BC) survivors who saw a GHP prior to genetic testing compared to those tested without involvement of a GHP.

Methods: A population-based sample of Black, Hispanic and non-Hispanic white (NHW) women diagnosed with invasive BC &lt; age 50 in 2009-2012 was recruited through the Florida State Cancer Registry. Participants were asked to complete a questionnaire and medical records release to verify clinical information and genetic test results. Women tested through a GHP were compared to those tested through a non-GHP based on the following variables: 1) Socioeconomic status (SES) (income, college education and private insurance); 2) Racial group (Black, Hispanic and NHW); and 3) Clinical factors (age at diagnosis, family history (FH) of breast or ovarian cancer and triple negative breast cancer (TNBC) status) using Pearson chi-squared analyses.

Results: Of 1618 study participants, 1080 reported genetic counseling and/or testing, of which provider information was verified on 981 based on documentation in medical record and/or genetic test result report. GHP involvement (either through consultation and/or test ordering) was reported in 193 women (19.7%) whereas the remaining 788 women (80.3%) had no documentation of GHP involvement. There was a significantly higher rate of GHP involvement among women with TNBC compared to those without TNBC (26.1% vs. 19.1%; p=0.05); and non-significant increases in those with and without a FH of BC (21.1% vs. 17.6%; p=0.17); and ovarian cancer (22.8% vs. 19.2%; p=0.34). GHP involvement did not vary among: 1) women diagnosed &lt; or &gt; age 45 (19.6% vs. 19.8%; p=0.96); 2) Blacks (20.1% vs. 19.6%; p=0.88); 3) Hispanics (23.5% vs. 18.8%; p=0.15); and 4) NHW (18.5% vs. 22%; p=0.19). Regarding SES-related indicators, GHP involvement was lower among women with private insurance versus those without (18.3% vs. 29.3%; p=0.002), annual household income &gt; $25,000 versus those &lt; $25,000 (18.8% vs. 30.8%; p=0.004) and a college education (55.4% vs. 60.9%; p=0.17).

Conclusions: Our results demonstrate that TNBC status was associated with testing through a GHP, while other clinical and demographic variables were not associated with GHP involvement. This finding may be due to widespread recognition of a more aggressive disease phenotype and association of TNBC with hereditary disease. Furthermore, the inverse relationship between higher SES-related indicators and GHP involvement suggests that those with higher SES are less likely to receive care through a GHP, as recommended per national guidelines.

Citation Format: Sonya Reid, Deborah Cragun, Ann Tezak, Anne Weidner, Ingrid Mayer, Xiao-ou Shu, Susan Vadaparampil, Tuya Pal. Patterns of BRCA testing by provider type based on biological and non-biological factors among a diverse sample of young breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2427.