Racial Disparity Seen in Use of Germline Testing in TNBC


Nicholas J. Robert, MD, discusses a study of the social determinants of a patient’s health related to the use of genomic testing in women with breast cancer.

Nicholas J. Robert, MD, chief medical officer of Ontada, discusses a study of the social determinants of a patient’s health related to the use of genomic testing in women with breast cancer.

The study explored the use of germline testing of women with triple-negative breast cancer (TNBC) who were patients in US Oncology Network practices.1 Germline testing is recommended for all patients with TNBC and can identify germline BRCA1/BRCA2 mutations responsible for developing breast cancer. Genomic profiling of patients with TNBC can inform how physicians manage patients during breast cancer surveillance and treatment.

The investigators looked at a group of women aged 60 or younger and found 74% overall had received germline testing, which was significantly higher than the 24% who received it according to a study published in 2018. Robert says the higher rate of testing could be partially explained by surveying patients in practices with active genetic screening programs.

The investigators reported at the 2023 American Society of Clinical Oncology Annual Meeting (ASCO) that only 67% of African American women received germline testing compared with 75% of white women. Other factors such as geographic region and socioeconomic conditions also impacted the rate of testing, with lower rates in the South and Midwest regions. Robert says they plan to analyze these data with a multivariate analysis to see precisely which factors affect how patients receive genomic testing.

According to Robert, this aspect of the study raised awareness that there is a greater need to identify all patients who should receive germline genetic testing and avoid excluding any patients who may be at higher risk during surveillance and treatment because of genetic factors.


0:08 | We identified a group of women that included African Americans, and we identified testing rates for germline testing. We did find that overall, the group did very well, [over] 70% got germline testing, much higher than we would expect. Partly that was due because these patients were or are in practices that had a very active genetic screening program. But we did find that African American women were tested a bit less than White women. We did find some other factors, in terms of where the region they live, for example. This has been reported at ASCO, and we will subsequently do a what we call a multivariate analysis to see if there if we can understand this better. But it certainly has raised awareness within our network that we need to identify all patients that are appropriate for testing.


1. Reid RL, Dye J, Leong T, et al. The impact of social determinants of health (SDOH) on use of germline genetic testing for triple-negative breast cancer (TNBC) in the community oncology setting. J Clin Oncol. 2023;41(suppl_16):1094. doi:10.1200/JCO.2023.41.16_suppl.1094

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