Social Determinants of Health Impact Germline Testing Rates Among Patients With TNBC

Barb Kunz, MS, LCGC, senior genetic counselor at the US Oncology Network, shared insight on a study she and colleagues conducted to assess the impact of social determinants of health in the context of germline genetic testing for triple-negative breast cancer in the community oncology setting.

Transcript

Which social determinants of health were most impactful on germline genetic testing rates among patients in the study?

So in this study, the one that really came up to the top was race. Black patients really had lower testing rates than White patients or Asian patients, actually. And that is something that we need to understand more why that's happening. And they have higher rates of triple negative breast cancer, so we need to understand more about that.

The other thing that was significant was the type of insurance people had. So the testing rates were higher for people who had private insurance or Medicaid, and it was lower for Medicare and private pay. And so, why is that? And can we affect that piece? This information might help us address some of these.

There were also a few other things that were significant, like the region in which a patient was, and age. There was a small difference in age—I think 4 and a half years between those who were tested and those who were not tested, so younger patients were more likely to get tested.

Can you discuss the overall importance of studying germline genetic testing uptake in the community oncology setting?

Well, first, I think we did not even understand what our testing rate was in the community oncology setting in this population. So it actually took some work to look at medical records, where are things documented, where things weren't documented. So learning that piece was really important, and and I think we learned a lot about where data is. I mean, people get tested before they even come to the oncologist, and does that information come over to the oncologist? So we learned a lot about that—about where it's documented and how to better [it, and] what the best practice is for that. And then, communication with our practices. All of the practices that participated in this study were practices that had a strong genetics program, and they're part of our GREAT network, which stands for genetic risk evaluation and testing. So it's a program a network of genetic providers. And so we have a strong genetic core in those practices, but we learned a lot about that we still need to work on with our with our oncologists and other other providers to make sure that these patients are getting what they need.