Comparative analysis of hereditary cancer genetic testing programs in India and the US: Identifying disparities and guiding global program development.

Abstract

e13531 Background: Identifying actionable pathogenic variants in hereditary cancer genes is critical to assess eligibility for targeted therapies and locate at-risk relatives. Currently, little is known about disparities and trends in patients seen in India and other LMICs (low/middle income countries) compared to the US. Creating and analyzing metrics allows researchers to identify, track and reduce these inequities. Most patients seen in the Indian program are cancer patients referred internally (by their oncologist within the same health system). Counseling and testing are performed by one genetic counselor and one oncologist using NCCN criteria. The American clinic sees internal referrals, external referrals, and high-risk unaffected patients. The clinic is staffed by multiple providers including three genetic counselors. Methods: Characteristics of patients seen in both centers from 2022-2024 were compared in this unique dataset. This data was reviewed to identify disparities and trends in genetic testing both across centers and over time. Results: Summary data is presented in the table below. Patient volumes at both centers increased significantly over time. In contrast to India, the majority of patients evaluated at the US center are now unaffected. Female patients represent over 80% of patients seen in both clinics. A personal or family history of breast cancer remains the most common reason for referral in both clinics. The percentage of pathogenic/likely pathogenic variants (P/LP) is markedly higher in the Indian patients tested. In the Indian clinic, referred patients are seen within two days, whereas wait times in the US clinic may be up to four weeks. Conclusions: These cross-national results provide real-world evidence of disparities in germline cancer genetic testing. Training additional genetics providers is critical to improving testing volume. In both nations, sex is the dominant disparity noted in genetic testing; special emphasis should be placed on identifying male patients who meet criteria for testing. Programs must also focus on testing eligible patients with cancer types other than breast cancer. Evaluating high-risk unaffected patients and emphasizing cascade testing will amplify the impact of genetic testing. When developing and expanding testing programs worldwide, our data can be used to preemptively address and reduce these inequities. Patient characteristics from MCCF (IN/India) & VOA (US) genetic clinics. Year 2022 2023 2024 IN total 149 168 272 US total 1661 1912 2534 IN % unaffected 21% 14% 8% US % unaffected 41% 44% 55% IN % female 83% 88% 90% US % female 82% 80% 80% IN personal/family history of breast cancer 54% 60% 59% US personal/family history of breast cancer 43% 41% 41% IN % P/LP variants 21% 20% 14% US % P/LP variants 11% 12% 12%