Achieving equity in genomic testing for breast cancer through partner-led strategies and policies.
Year: 2025
Type: conference-abstract
Abstract: 11027 Background: Genomic testing is recommended for individuals with estrogen/progesterone receptor-positive, HER2-negative early-stage breast cancer to determine the need for chemotherapy alongside endocrine therapy. However, access disparities persist by race, ethnicity, and income. This study aims to identify modifiable barriers and co-design policy recommendations for equitable genomic testing for low-income, and racial and ethnic minoritized people with breast cancer in Northern California. Methods: Using community-based participatory research and expert panel methods, we collaborated with an 18-member expert panel of patients, caregivers, oncology clinicians, community organizations, advocates, and policymakers to identify modifiable barriers and propose solutions. Phase 1 involved an 85-question survey and semi-structured interviews with patients, caregivers, clinicians, navigators, policymakers, and payers, administered by bilingual community health workers in Spanish, Tagalog, and Chinese, to assess genomic testing barriers and solutions. Phase 2 used Delphi consensus methods with the expert panel to finalize policy recommendations. Results: Of 912 invited, 831 participated in surveys (90% response rate), and all 30 purposively sampled individuals participated in interviews (100% response rate). Survey participants included 514 patients, 101 caregivers, 94 clinicians, 74 navigators, 25 policymakers, and 23 payers. Among patients, 102 (19.8%) were Asian, 132 (25.7%) Black, 138 (26.9%) Hispanic White, 28 (5.5%) Non-Hispanic White, and the remainder preferred not to answer. Racial and ethnic minoritized patients had significantly lower odds of genomic testing compared to Non-Hispanic Whites: Black patients 86% lower (OR: 0.15; 95% CI: 0.07-0.31), Asian patients 71% lower (OR: 0.29; 95% CI: 0.14-0.59), and Hispanic White patients 79% lower (OR: 0.21; 95% CI: 0.11-0.43). Four themes emerged from interviews: 1) limited awareness/resources, 2) inequitable care, 3) financial/cultural barriers, and 4) insufficient social support. The expert panel reached consensus on policy recommendations, including mandating reflexive, fully reimbursed genomic testing (mean rating ± SD: 8.3 ± 0.9), eliminating prior authorization (8.2 ± 0.8), removing co-pays/out-of-pocket costs (8.1 ± 0.8), and providing educational materials in preferred languages with lay terminology (7.9 ± 1.2). Conclusions: Disparities in genomic testing persist, highlighting the need for targeted interventions. Policy recommendations co-designed with communities and other interested groups can be implemented to improve equitable care.
Source: Journal of Clinical Oncology
Institutions: Stanford Medicine, Stanford University, Meharry Medical College, University of California San Diego, Stanford Cancer Institute, San Ysidro Health, University of Southern California, University of California, San Francisco, University of California, Davis, Bay Area Community Health Advisory Council
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W4410809883