Racial Disparities in Accessing Care along the Continuum of Cancer Genetic Service Delivery.

BACKGROUND

Public health calls to ensure equity in genomics and precision medicine necessitate a closer examination of how these efforts might differentially affect access to genetic services across demographic subgroups. This study set out to examine racial/ethnic disparities along the cancer genetic service delivery continuum.

METHODS

Retrospective data are drawn from 15 clinical sites across 6 US States. Individuals who screened at-risk for hereditary cancer were 1) referred/scheduled to see a genetic counselor (referral workflow), or 2) offered genetic testing at the point-of-care (POC workflow). Logistic regression analyses evaluated the associations between race/ethnicity and several outcomes including appointment scheduling, genetic counseling, and genetic testing, controlling for demographics, clinical factors, and county-level covariates.

RESULTS

A total of 14,527 patients were identified at-risk. Genetic testing uptake was significantly higher at POC sites than referral sites (34% POC vs. 11% referral, p < 0.001). Race/ethnicity was significantly associated with testing uptake among all sites, with non- Hispanic Blacks having lower odds of testing compared to non-Hispanic Whites (aOR = 0.84, 95% CI 0.71, 1.00, p = 0.049). Moreover, this disparity was observed at referral sites, but not POC sites. Among patients scheduled, non-Hispanic Blacks had lower odds of counseling (aOR=0.28, 95% CI 0.17, 0.47, p < 0.001).

CONCLUSIONS

Findings suggest that factors influencing genetic counseling show rates may be driving disparities in genetic testing.

IMPACT

Strategies to reduce barriers to seeing a genetic counselor, including modifications to clinical workflow, may help mitigate racial/ethnic disparities in genetic testing.