Remote delivery of cancer genetic testing in veterans with metastatic prostate cancer - A Million Veteran Program pilot study

Sep 22, 2026

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Remote germline testing helps guide targeted therapy for metastatic prostate cancer and supports early detection and family risk reduction, yet real-world uptake remains low. This prospective Million Veteran Program pilot study enrolled veterans with metastatic prostate cancer, using mailed opt-out procedures, follow-up contact, and consent-supported saliva kit testing via a CLIA-level multigene panel with genetic counseling. Among eligible participants, completion exceeded prior reports, revealing clinically actionable pathogenic variants.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

DOI: 10. 1002/cncr.70283 ORIGINAL ARTICLE Remote delivery of cancer genetic testing in veterans with metastatic prostate cancer: A Million Veteran Program pilot study Bruce Montgomery MD 1,2,3 | Julie A. Lynch MBA, RN, PhD4,5 | Jessica Brown BA1 | Kara N. Maxwell MD, PhD6,7 | Craig C. Teerlink PhD4,5 | Nismeta Kabilovic BS 1 | Katie Stoll MS1,8 | Julie Simon MS 1,8 | Maria Kogan BA1 | Sajida Hassan PhD2 | Stacey B. Whitbourne PhD9 | Sumitra Muralidhar PhD 10 | Martin W. Schoen MD, MPH11 | Rachel Ramoni DMD 10 | J. Michael Gaziano MD9 | Alexandra O. Sokolova MD12 | Heather H. Cheng MD, PhD2,3 | Ruth Etzioni PhD3 | Colin C. Pritchard MD, PhD1,2,3, 13 1VA Puget Sound Health Care System, Seattle, Washington, USA 2University of Washington, Seattle, Washington, USA 3Fred Hutchinson Cancer Center, Seattle, Washington, USA 4VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA 5Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA 6Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA 7Department of Medicine-Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA 8Genetic Support Foundation, Olympia, Washington, USA 9Department of Medicine, Million Veteran Program Coordinating Center, Veterans Affairs Healthcare System, Boston, Massachusetts, USA 10Department of Veterans Affairs, Office of Research and Development, Washington, DC, USA 11VA St. Louis Health Care System, St. Louis, Missouri, USA 12Oregon Health and Science University, Portland, Oregon, USA 13Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA Correspondence Bruce Montgomery, VA Puget Sound HCS, 1660 S. Columbian Way, Seattle, WA 98108, USA. Email: [rbmontgo@uw.edu](rbmontgo@uw.edu) Funding information Institute for Prostate Cancer Research; National Cancer Institute, Grant/Award Number: P50CA097186; Congressionally Directed Medical Research Programs, Grant/ Award Numbers: W81XWH-17-2-0043, W81XWH2220021; Prostate Cancer Abstract Background: Germline pathogenic variants can inform targeted therapy for metastatic prostate cancer (mPC), and improve cancer early detection and risk reduction for family members. Guidelines recommend germline genetic testing be offered to all men with mPC, yet uptake of testing is only 10%–12%. Methods: This prospective study enrolled veterans participating in the VA Million Veteran Program (MVP) with a diagnosis of mPC. Veterans were contacted by mail with option to opt-out of future contact. Eligible veterans who did not opt-out were mailed study information and received a follow-up phone call to establish interest in This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Published 2026. This article is a U.S. Government work and is in the public domain in the USA. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society. Cancer. 2026;e70283. [https://doi.org/10.1002/cncr.70283](https://doi.org/10.1002/cncr.70283) wi[leyonlinelibrary.com/journal/cncr](leyonlinelibrary.com/journal/cncr) 1 of 8 Foundation, Grant/Award Numbers: Challenge Award, Young Investigator Award; US Department of Veterans Affairs, Grant/ Award Number: MVP031 germline testing. Participants provided verbal consent and were mailed a saliva collection kit for a CLIA-level multigene cancer predisposition gene panel test. Results were disclosed to the patient and oncology provider. All steps were performed with genetic counseling support. Results: Of 2104 eligible patients, 1952 veterans with mPC did not opt out. Of these, 681 (35%) provided cons

FAQs

What problem does the study address in metastatic prostate cancer?

Guidelines recommend germline genetic testing for men with metastatic prostate cancer, but uptake is reported to be only about 10%–12%. The study evaluates a remote delivery approach to improve completion rates.

How was remote genetic testing delivered to eligible veterans?

Eligible veterans were contacted by mail with an option to opt out, received study information and follow-up phone contact, and those consenting were mailed a saliva collection kit for a CLIA-level multigene cancer risk panel.

What were the key outcomes of remote testing completion?

Among 1952 veterans who did not opt out, 681 (35%) consented and 459 (24%) completed testing. Completion occurred at higher rates than previously reported, and a subset of completed cases carried germline pathogenic variants.

Sep 22, 2026

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