Utilization of risk-reducing interventions among breast cancer patients with pathogenic germline variants across safety-net and academic hospitals.

Abstract

e22546 Background: Risk-reducing interventions (RRI) reduce cancer risk for patients with pathogenic/likely pathogenic germline variants (PGV) associated with hereditary breast cancer. Uptake varies widely and may be influenced by stage at diagnosis, PGV penetrance, race, and healthcare setting. Data describing RRI utilization by stage and PGV risk, particularly in safety-net systems, remain limited. Methods: We conducted a retrospective cohort study of breast cancer patients with PGV treated at Harris Health System (HHS), a public safety-net hospital, and Baylor St. Luke’s Medical Center (BSLMC), a private academic hospital. Patients diagnosed between October 2009 and September 2019 were included (N = 404; 151 HHS, 253 BSLMC). PGVs were categorized as high-risk (BRCA1, BRCA2, PALB2, PTEN, TP53), or moderate-risk (ATM, CHEK2, other). RRI included risk-reducing breast or gynecologic surgery. Descriptive statistics summarized RRI rates by stage at diagnosis, PGV risk, race, and hospital system. Results: RRI utilization was observed across stages 0 - III, with higher rates among patients diagnosed at earlier stages; no RRIs were observed among stage IV patients. Patients with high-risk PGVs consistently demonstrated higher RRI rates than those with moderate-risk PGVs at all stages. RRI utilization was higher at HHS than at BSLMC, particularly among patients with high-risk PGVs, with variation persisting by stage and PGV risk across hospital systems. Hispanic patients were most likely to undergo RRI and were predominantly treated at HHS. Conclusions: RRI utilization among breast cancer patients with PGVs varies by stage at diagnosis, PGV risk, and healthcare setting. Higher uptake among patients with high-risk PGVs and earlier-stage disease highlights the role of clinical context in RRI decision-making. These findings support further investigation into how access, counseling, and system-level factors influence equitable delivery of risk-reducing care. Percentage of patients utilizing risk-reducing interventions by stage and pathogenic germline variant at safety-net and academic hospital. Overall High-Risk% (Total n) Overall Moderate- Risk% (Total n) Safety-Net High-Risk% (Total n) Safety-Net Moderate- Risk% (Total n) Academic Hospital High-Risk% (Total n) Academic Hospital Moderate- Risk% (Total n) Stage 0 86.67 (15) 23.53 (17) 88.89 (9) 0.00 (2) 83.33 (6) 26.67 (15) Stage I 65.79 (38) 32.26 (31) 75.00 (16) 40.00 (5) 59.09 (22) 30.77 (26) Stage II 70.15 (67) 26.67 (30) 80.49 (41) 50.00 (4) 53.85 (26) 23.08 (26) Stage III 64.71 (51) 31.58 (19) 67.57 (37) 20.00 (5) 57.14 (14) 35.71 (14) Stage 0-1 71.70 (53) 29.17 (48) 80.00 (25) 28.57 (7) 64.29 (28) 29.27 (41) Stage II-III 67.80 (118) 28.57 (49) 74.36 (78) 33.33 (9) 55.00 (40) 27.50 (40) High-risk PGVs include BRCA1, BRCA2, PALB2, PTEN, P53. Medium-risk PGVs include ATM, CHEK2, other.