UPJ INSIGHT: Cancer-based Genetic Testing in Healthy U.S. Adults vs Those With Prostate or Breast/Ovarian Cancer
By: Sameer Thakker, MD; Stacy Loeb, MD; Veda N. Giri, MD; Marc A. Bjurlin, MD; Richard S. Matulewicz, MD | Posted on: 17 Jan 2023
Thakker S, Loeb S, Giri VN, Bjurlin MA, Matulewicz RS. Attitudes, perceptions, and use of cancer-based genetic testing among healthy U.S. adults and those with prostate or breast/ovarian cancer. Urol Pract. 2023;10(1):26-32.
Study Need and Importance
The ability to provide genetic testing in the management of cancer has allowed for the identification of high-risk patients who would benefit from early counseling, screening, and diagnosis. The importance of genetic testing in breast and ovarian cancer has been known for many years. More recently, genetic evaluation has also had an increasing role in prostate cancer management and care. Given the relatively new focus on genetic testing in prostate cancer, it remains unclear how frequently men with prostate cancer are undergoing genetic testing, how information on testing is disseminated, and what patient perceptions are towards the role of genetics in prostate cancer. Therefore, our goal was to examine perceptions and uptake of genetic testing in patients with breast/ovarian cancer, compared to patients with prostate cancer, and the general public.
What We Found
In a nationally representative sample of 231.7 million (M) adults, 3.7 M adults reported a history of breast/ovarian cancer while 1.5 M patients reported a history of prostate cancer. 52.3% of patients with breast/ovarian cancer vs 1.0% with prostate cancer reported undergoing cancer-specific genetic testing (P = .001). Patients with prostate cancer were less aware of cancer-specific genetic testing than either individuals with breast/ovarian cancer or adults without a cancer history (19.7% vs 64.7% vs 35.8%, respectively; P = .003). Health care professionals were the most common source of genetic testing information for patients with breast/ovarian cancer whereas the Internet was the most common source for patients with prostate cancer.
While the nationally representative survey lacked the granular oncologic data needed to assess the percentage of respondents who would have met criteria for prostate cancer genetic testing, an overall testing rate of ∼1% in the setting of low provider and patient awareness still suggests that there is a discrepancy between the number of eligible patients vs those who receive genetic testing. In addition, we excluded individuals with multiple cancers, who may be more likely to undergo genetic testing. However, the goal of this analysis was to compare relative frequencies of testing between specific cancer types.
Interpretation for Patient Care
Our study provides evidence of gaps in awareness and differences in the perceptions of genetic testing among men with prostate cancer compared to individuals with breast/ovarian cancer or those without cancer. Our results highlight the need for increased awareness and education about the importance of germline genetic factors, including health care settings as well as digital and social platforms. Additionally, increased provider counseling on genetic testing at time of initial diagnosis/workup may translate to a higher percentage of patients undergoing genetic evaluation.