Screening and Outcomes of Hereditary Cancer Syndromes: A Study at an Urban Safety Net Hospital

Study Background

Patients with Hereditary Cancer Syndromes (HCS) have a higher lifetime risk of developing cancer. Historically, underserved populations have lower rates of genetic evaluation. Hence, researchers aim to understand the demographic factors involved in HCS assessments within an urban safety net patient population.

Article Information

This study was conducted by Sydney Brehany, MD; Meryl Colton, MD; Cassandra Duarte, MD; Michael Baliton, BS; Alec S. McCranie, BA; and Sonia Okuyama, MD. It was published in the journal “JCO Precision Oncology” by the American Society of Clinical Oncology on June 27, 2024. The study received approval from the Institutional Review Board and used a retrospective chart review method to collect data.

Research Methods

The study included patients diagnosed with breast cancer, ovarian/fallopian tube cancer, colorectal cancer, pancreatic cancer, and prostate cancer at an urban safety net hospital from 2016 to 2021. Eligibility for genetic testing for hereditary cancer was confirmed using National Comprehensive Cancer Network (NCCN) guidelines. Collected data included age, sex, race, ethnicity, language, type of insurance, family history of cancer, time of diagnosis, Eastern Cooperative Oncology Group (ECOG) status, and Charlson Comorbidity Index (CCI). Statistical analyses involved univariate and multivariate logistic regression models.

Study Results

A total of 637 patients were included, with 40% undergoing genetic testing. Univariate analysis revealed that living patients, females, Latino groups, Spanish speakers, those with a family history of cancer, and those referred for genetic testing were more likely to undergo genetic testing. Having public insurance, pancreatic or prostate cancer, advanced-stage patients, ECOG prognosis score ≥ 1, higher CCI, current or past tobacco use, and past alcohol use were negatively associated with genetic testing rates. In the multivariate model, only a family history of cancer was positively correlated with undergoing genetic testing.

Study Conclusion

The rates of HCS screening were lower for Black patients, colorectal or prostate cancer patients, and those with an ECOG score of 2. Efforts to increase HCS testing for these patients are crucial for promoting equitable cancer care.

Significance and Value of the Study

This study reveals demographic disparities in hereditary cancer screening, especially among historically underserved populations. By increasing screening efforts for these groups, more equitable cancer care can be achieved.

Highlights and Unique Aspects of the Study

The highlight of the study is the in-depth analysis of specific populations (non-white groups and uninsured) and their likelihood of undergoing HCS evaluations and associated factors. Furthermore, the study emphasizes the positive role of language factors (especially Spanish) in cancer screening, which is rarely discussed in existing literature.

Other Valuable Information

This study provides directions for improving screening efforts for high-risk but underserved populations, offering healthcare providers more information to understand which patients might miss necessary genetic testing and follow-up services.