Hereditary Cancer Screening and Outcomes at an Urban Safety-Net Hospital - Original Reports

Sep 21, 2026

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Hereditary cancer syndromes confer a high lifetime cancer risk, yet historically underserved groups show lower rates of genetic evaluation. This study characterizes demographic factors linked to receiving hereditary cancer screening in an urban safety-net patient population. Patients meeting criteria for multiple pathologically confirmed cancers were analyzed from 2016 to 2021 using retrospective chart review and logistic regression models.

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Original Reports | Cancer Genetics Hereditary Cancer Screening and Outcomes at an Urban Safety-Net Hospital Sydney Brehany, MD1 ; Meryl Colton, MD1 ; Cassandra Duarte, MD1; Michael Baliton, BS2 ; Alec S. McCranie, BA2 ; and Sonia Okuyama, MD3 DOI [https://doi.org/10.1200/PO.23.00699](https://doi.org/10.1200/PO.23.00699) | ABSTRACT | | | --- | --- | | PURPOSE | Patients with hereditary cancer syndromes (HCS) have a high lifetime risk of developing cancer. Historically underserved populations have lower rates of genetic evaluation. We sought to characterize demographic factors that are associated with undergoing HCS evaluation in an urban safety-net patient population. | | METHODS | All patients who met inclusion criteria for this study from 2016 to 2021 at an urban safety-net hospital were included in this analysis. Inclusion criteria were pathologically conﬁrmed breast, ovarian/fallopian tube, colon, pancreatic, and prostate cancers. Patients also qualiﬁed for hereditary breast and ovarian cancers or Lynch syndrome on the basis of National Comprehensive Cancer Network guidelines. Institutional review board approval was obtained. Demographic and oncologic data were collected through retrospective chart review. Univariable and multivariable logistic regression models were constructed. | | RESULTS | Of the 637 patients included, 40% underwent genetic testing. Variables associated with receiving genetic testing on univariable analysis included patients living at the time of data collection, female sex, Latinx ethnicity, Spanish language, family history of cancer, and referral for genetic testing. Patients identifying as Black, having Medicare, having pancreatic or prostate cancer, having stage IV disease, having Eastern Cooperative Oncology Group (ECOG) prognostic score ≥1, having medium or high Charlson comorbidity index, with current or previous cigarette use, and with previous alcohol use were negatively associated with testing. On multivariable modeling, family history of cancer was positively associated with testing. Patients identifying as Black, having colon or prostate cancer, and having ECOG score of 2 had signiﬁcantly lower association with genetic testing. | | CONCLUSION | Uptake of HCS was lower in patients identifying as Black, those with colon or prostate cancer, and those with an ECOG score of 2 . Efforts to increase HCS testing in these patients will be important to advance equitable cancer care. | Accepted April 26, 2024 Published June 27, 2024 JCO Precis Oncol 8:e2300699 © 2024 by American Society of Clinical Oncology Creative Commons Attribution Non-Commercial No Derivatives 4.0 License INTRODUCTION Hereditary cancer syndromes (HCS) are uncommon conditions; however, individuals with an identiﬁed gene mutation may have up to an 80% lifetime risk of developing cancer. The two most common HCS, hereditary breast and ovarian cancer (HBOC) syndrome and Lynch syndrome, affect approximately 1:400 and 1:279 individuals, respectively, with some populations harboring mutations at much higher rates.1,2 Despite this, more than half of at-risk individuals have not undergone genetic testing.3 There are patient, health care provider, and system barriers to undergoing genetic evaluation. Patient factors include poor understanding of the importance of their family history and not being aware of genetic services available.4 For healthcare providers, poor family history taking, lack of knowledge of genetic risk factors and genetic services, and inadequate referral coordination have been identiﬁed as barriers.4 Additionally, variation in testing criteria guidelines, especially as these change over time, and guidelines failing to capture all affected patients exacerbate difﬁculties for health care providers to identify patients to refer for adequate care.5-11 Unfortunately, historically underserved populations tend to fare worse. Several studies have shown that racial and ethnic minorities are less likely to

FAQs

What was the study’s primary objective regarding hereditary cancer screening?

To describe the demographic factors associated with receipt of hereditary cancer screening in an urban safety-net cancer patient population.

Which factors were positively associated with undergoing genetic testing on multivariable analysis?

Family history of cancer was positively associated with receiving genetic testing.

How did genetic testing uptake differ among patient subgroups in the study?

Uptake of hereditary cancer screening was lower among patients identifying as Black, those with colon or prostate cancer, and those with an Eastern Cooperative Oncology Group score of 2.

Sep 21, 2026

Uploaded by Asher