Abstract P1-01-01: Mainstream Cancer Genetics Testing in Primary Care at a Federally Qualified Health Center: Preliminary Findings from the TestMiGenes Study

Abstract Introduction: Mainstream genetic testing (MGT) has been proposed as an alternative model to scale access to cancer genetic services utilizing established care providers to provide point-of-care genetic testing at the time of risk identification. However, MGT has primarily been adopted in the oncology setting. Expanding MGT into the primary care (PC) setting leverages the trusted relationship of providers within the patient’s medical home increasing the opportunity for primary prevention. In 2023, the University of Illinois Cancer Center partnered with the Mile Square Health Center, a system of federally qualified health centers, to initiate a quality improvement (QI) initiative promoting the prevention and early detection of cancer through universal hereditary cancer risk assessment (HCRA) across PC sites. Building off this QI initiative is the TestMiGenes study, which compares the effectiveness of a standard-of-care referral model enhanced with navigation support to a mainstream/point-of-care testing (MGT) model on the uptake of genetic testing among adults identified at risk for hereditary cancer syndromes in PC settings. Methods: A digital HCRA tool, developed in English and Spanish at a 7th-grade reading level, was administered by navigators to patients aged 25 and older presenting for routine PC visits across multiple FQHC sites. The HCRA tool identified patients meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing eligibility based on reported personal and family history. Patients who met NCCN criteria for genetic testing (GT) on HCRA received either a referral to genetic counseling or were offered GT by their PC provider (MGT). From January to December 2023, the referral model was implemented with 10 PC providers across 2 clinics. Eight PC providers from these 2 clinics transitioned to the MGT model from September 2023 to mid-May 2024. PC providers were trained to provide brief education and conduct shared decision-making around HCRA, placing GT orders, and GT result disclosure via multiple educational sessions with cancer genetic counselors and cancer risk specialists. Results: Overall, 1555 patients received HCRA, and 300 were eligible for GT. The majority of screened patients were Black or Hispanic (84%), under the age of fifty (52%), and female (68%). Of those eligible for GT, 68 received cancer genetic services under the MGT model and 232 received services under the referral model. Uptake of genetic testing was significantly higher among patients cared for in the MGT model (35%, n=24) compared to the referral model (23%, n=53) (p<0.05). Time from identification of GT eligibility to completion of GT also differed significantly from 7 days in the MGT model to 93 days in the referral model (p < 0.05). Of note, only 40% (n=69) of those eligible for GT in the referral model completed a GC visit, pointing to additional barriers in the current standard of care process. Conclusion: Preliminary data suggests that an MGT model is feasible in the PC setting and can potentially increase uptake and reduce wait time for GT. Notably, cancer genetic services are underutilized in both models likely due to multilevel barriers. Further research is needed to explore acceptability, sustainability, facilitators and barriers, and potential harms of both MGT and referral models in PC. The TestMiGenes study is currently conducting patient and provider interviews to explore stakeholder perceptions of GT in primary care. Citation Format: Pamela Ganschow, Vivian Pan, Angelina Izguerra, , Genesis Rios , Neha Awati. Mainstream Cancer Genetics Testing in Primary Care at a Federally Qualified Health Center: Preliminary Findings from the TestMiGenes Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-01-01.