Abstract P027: Interest and uptake rates for cancer risk genetic testing in the AHEAD early detection program
Authors: Westgate Candace Theal 
Published: January 2023

Abstract
Genetic testing for hereditary breast and ovarian cancer syndrome (HBOC) and Lynch syndrome have both been defined as Tier 1 genomic applications for their significant potential for positive impact on public health, as early cancer interception could greatly reduce mortality among the millions of people at increased risk. However, the integration of this genetic screening into standard-of-care workflows has proven to be challenging due to factors such as clinical resources, patient access, cost and insurance, or patient education and perceptions. More recently, alternative care-delivery models such as tele genetics or “mainstreaming” genetic testing have been popularized as a route to providing more access and less burden that the traditional referral-based pre-test counseling model. This study analyzed the uptake of recommended genetic testing for hereditary cancer from the Adventist Health Early All-Around Detection (AHEAD) program, which is a system-wide initiative aimed at expanding access to genetic screening for cancer risk. The purpose of this analysis is to understand associations between the uptake of genetic testing, and factors such as population demographics, socioeconomics, or care-delivery models, in order to inform and improve the implementation design of the AHEAD program and similar efforts, ultimately improving care and outcomes for the whole patient population. A retrospective data analysis was performed from January 2021 to July 2022 of individuals from 48 clinical locations across California, Oregon, and Hawaii, who went through the AHEAD screening program. A total of 4,922 out of 19,258 individuals met NCCN criteria for HBOP and Lynch syndrome. Of these “high-risk” individuals, 2,666 (54.2%) were interested in genetic testing and of those, 2,313 (86.8%) underwent testing. The analysis demonstrated that interest in genetic testing differed among patient age groups (243, 49.4% in Under 30; 426, 58% in 30-40; 597, 60% in 40-50; 574, 56.7% in 50-60; 501, 50% in 60-70 and 325, 47.6% in 70 and above) and clinic types (1549, 62.5% RHC vs. 663, 52.5% non-RHC). Of patients that were interested, those who went through a single-appointment, point-of-care testing (POCT) model were more likely to follow through with testing than a multiple-appointment, non-POCT model (odds ratio of 1.5, 95% confidence interval of 1.18 to 1.91). The study results showed that interest and uptake of genetic testing may be influenced by demographic or socioeconomic factors, as well as care-delivery models. The difference in testing follow through may indicate that POCT could be a more effective model for increasing genetic testing in certain populations. These results from the AHEAD program suggest that alternative care-delivery models such as telegenetics or "mainstreaming" can provide patients access to genetic screening. Future work should focus on understanding barriers and attitudes among different groups and designing targeted strategies for increasing genetic testing uptake across all groups.
Citation Format: Candace Theal Westgate. Interest and uptake rates for cancer risk genetic testing in the AHEAD early detection program. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P027.