Hereditary breast and ovarian cancer (HBOC) genetic testing uptake were low among underserved women being screened for breast cancer, according to results of a study published in The Oncologist.

Uptake of guidelines from the United States Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN) on HBOC genetic testing is also low among women with a personal or family history of cancer.

This prospective feasibility study was conducted at The Rose Clinics, a nonprofit organization serving low-income communities in Texas. Women who presented for mammography between 2020 and 2021 (N=501) were assessed for HBOC genetic testing using a cancer genetics risk assessment (CGRA). The subset of women eligible for genetic testing (n=150) received educational materials. A subset of women with a pathogenic variant (PV) or variant of uncertain significance (VUS) were contacted remotely for genetic counseling.

The women were aged median 52.0 (range, 21 to 79) years, 50.3% were White, 30.1% were uninsured, and they had a median salary of $45,000.

A personal history of breast or ovarian cancer was reported by 4.9% of the women, including 5 (1.0%) with triple-negative breast cancer. Family histories of breast cancer (37.7%), ovarian cancer (10.4%), pancreatic cancer (6.6%), and prostate cancer (6.0%) were reported.

Nearly one-third of the women (29.9%) were eligible for genetic testing, of whom 81.3% received educational materials. Of these, 100 women were contacted and offered a genetic testing kit; 19 agreed to complete testing, 14 (9.3% of those eligible) of whom returned the kit. The testing detected VUS in 2 patients and PV in 1 patient; the other 11 patients had negative results.

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Given the small proportion of patients who completed testing, the next project phase will focus on improving convenience for patients and developing strategies to overcome patient and program-related barriers to [genetic testing] completion.

Predictors for completing genetic testing included Native American or Alaskan Native heritage (odds ratio [OR], ∞; P =.0081), Ashkenazi Jewish heritage (OR, 21.5; P =.015), and White race (OR, 5.2; P =.025); age younger than 50 (OR, 5.2; P =0.25); spoke Spanish as a primary language (OR, 1.7; P =.71); and reported an income of less than $70,000 a year (OR, 5.2; P =.13).

The most common reasons for not undergoing genetic testing included not wanting to know results (14.6%) and not having time (7.3%). However, nearly half of women who did not undergo testing (48.8%) could not be reached to ask their reason for declining.

The use of a simple screening tool successfully identified patients at high risk of HBOC who had not previously undergone [genetic testing]. However, these results are limited by the study’s small sample size.

“Given the small proportion of patients who completed testing, the next project phase will focus on improving convenience for patients and developing strategies to overcome patient and program-related barriers to [genetic testing] completion,” said the researchers.