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Racial Differences in Germline Genetic Testing Completion Among Males With Pancreatic, Breast, or Metastatic Prostate Cancers

Jeffrey W. Shevach, Danielle Candelieri-Surette, Julie A. Lynch, Rebecca A. Hubbard, Patrick R. Alba, Karen Glanz, Ravi B. Parikh, and Kara N. Maxwell

Background: Germline genetic testing is a vital component of guideline-recommended cancer care for males with pancreatic, breast, or metastatic prostate cancers. We sought to determine whether there were racial disparities in germline genetic testing completion in this population. Patients and Methods: This retrospective cohort study included non-Hispanic White and Black males with incident pancreatic, breast, or metastatic prostate cancers between January 1, 2019, and September 30, 2021. Two nationwide cohorts were examined: (1) commercially insured individuals in an administrative claims database, and (2) Veterans receiving care in the Veterans Health Administration. One-year germline genetic testing rates were estimated by using Kaplan-Meier methods. Cox proportional hazards regression was used to test the association between race and genetic testing completion. Causal mediation analyses were performed to investigate whether socioeconomic variables contributed to associations between race and germline testing. Results: Our cohort consisted of 7,894 males (5,142 commercially insured; 2,752 Veterans). One-year testing rates were 18.0% (95% CI, 16.8%–19.2%) in commercially insured individuals and 14.2% (95% CI, 11.5%–15.0%) in Veterans. Black race was associated with a lower hazard of testing among commercially insured individuals (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.58–0.91; P=.005) but not among Veterans (aHR, 0.99; 95% CI, 0.75–1.32; P=.960). In commercially insured individuals, income (aHR, 0.90; 95% CI, 0.86–0.96) and net worth (aHR, 0.92; 95% CI, 0.86–0.98) mediated racial disparities, whereas education (aHR, 0.98; 95% CI, 0.94–1.01) did not. Conclusions: Overall rates of guideline-recommended genetic testing are low in males with pancreatic, breast, or metastatic prostate cancers. Racial disparities in genetic testing among males exist in a commercially insured population, mediated by net worth and household income; these disparities are not seen in the equal-access Veterans Health Administration. Alleviating financial and access barriers may mitigate racial disparities in genetic testing.

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Volume 22 (2024): Issue 2.5 (Apr 2024): Abstracts from the NCCN 2024 Annual Conference

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BIO24-030: Unifying Multimodal Data, Time Series Analytics, and Contextual Medical Memory: Introducing MINDS as an Oncology-Centric Cloud-Based Platform

Aakash Tripathi, Asim Waqas, and Ghulam Rasool

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BIO24-031: Hierarchical Multimodal Learning on Pan-Squamous Cell Carcinomas for Improved Survival Outcomes

Asim Waqas, Aakash Tripathi, Ashwin Mukund, Paul Stewart, Mia Naeini, and Ghulam Rasool

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BIO24-032: Early Diagnosis of Cancer Cachexia Using Body Composition Index as the Radiographic Biomarker

Sabeen Ahmed, Nathan Parker, and Ghulam Rasool

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BPI24-008: Pumping Iron in the Preoperative Period: Is It Beneficial in Reducing Blood Transfusions?

Carla Patel, Danielle Fournier, Susan Knippel, Cheryl Fraser, TaCharra Laury, Hue Cao, Mini George, and Arlene Correa

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BPI24-009: Improving Adherence to Safe Handling of Oral Hazardous Drugs and Contaminated Wastes Guidelines

Eliane Vieira, Grace Allen, and Sadeeka Al-Majid

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BPI24-010: Temporary Toilet Lids Minimize Contamination of Bathroom Surfaces With Hazardous Drugs

Eliane Vieira, Grace Allen, and Sadeeka Al-Majid

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BPI24-011: Impact of Obesity on Sentinel Lymph Node Mapping in Patients With Endometrial Intraepithelial Neoplasia Undergoing Robotic Surgery

Tomer Bar Noy, Yossi Tzur, Yoav Brezinov, Emad Matanes, Susie Lau, Shannon Salvador, Melica Nourmoussavi Brodeur, and Walter Gotlieb

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BPI24-012: Comparing Cancer Risk Management Between Females With Truncating CHEK2 1100delC Versus Missense CHEK2 I157T Variants

Diego Garmendia, Anne Weidner, Lindsay Venton, and Tuya Pal