Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC.
VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT.
J Natl Compr Canc Netw. 2024 Apr 17;22(4):237-243. doi: 10.6004/jnccn.2023.7105.
Germline genetic testing is a vital component of guideline-recommended cancer care for males with pancreatic, breast, or metastatic prostate cancers. We sought to determine whether there were racial disparities in germline genetic testing completion in this population.
This retrospective cohort study included non-Hispanic White and Black males with incident pancreatic, breast, or metastatic prostate cancers between January 1, 2019, and September 30, 2021. Two nationwide cohorts were examined: (1) commercially insured individuals in an administrative claims database, and (2) Veterans receiving care in the Veterans Health Administration. One-year germline genetic testing rates were estimated by using Kaplan-Meier methods. Cox proportional hazards regression was used to test the association between race and genetic testing completion. Causal mediation analyses were performed to investigate whether socioeconomic variables contributed to associations between race and germline testing.
Our cohort consisted of 7,894 males (5,142 commercially insured; 2,752 Veterans). One-year testing rates were 18.0% (95% CI, 16.8%-19.2%) in commercially insured individuals and 14.2% (95% CI, 11.5%-15.0%) in Veterans. Black race was associated with a lower hazard of testing among commercially insured individuals (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.58-0.91; P=.005) but not among Veterans (aHR, 0.99; 95% CI, 0.75-1.32; P=.960). In commercially insured individuals, income (aHR, 0.90; 95% CI, 0.86-0.96) and net worth (aHR, 0.92; 95% CI, 0.86-0.98) mediated racial disparities, whereas education (aHR, 0.98; 95% CI, 0.94-1.01) did not.
Overall rates of guideline-recommended genetic testing are low in males with pancreatic, breast, or metastatic prostate cancers. Racial disparities in genetic testing among males exist in a commercially insured population, mediated by net worth and household income; these disparities are not seen in the equal-access Veterans Health Administration. Alleviating financial and access barriers may mitigate racial disparities in genetic testing.
对于患有胰腺癌、乳腺癌或转移性前列腺癌的男性，种系基因检测是指南推荐的癌症护理的重要组成部分。我们旨在确定在这一人群中，种系基因检测的完成是否存在种族差异。
本回顾性队列研究纳入了 2019 年 1 月 1 日至 2021 年 9 月 30 日期间患有新发胰腺癌、乳腺癌或转移性前列腺癌的非西班牙裔白种男性和黑种男性。研究考察了两个全国性队列：（1）在行政索赔数据库中参保的商业保险个体；（2）在退伍军人事务部接受治疗的退伍军人。采用 Kaplan-Meier 法估计种系基因检测的 1 年完成率。采用 Cox 比例风险回归检验种族与基因检测完成之间的关联。进行因果中介分析以调查社会经济变量是否导致种族与种系检测之间存在关联。
我们的队列由 7894 名男性组成（5142 名商业保险个体；2752 名退伍军人）。商业保险个体的 1 年检测率为 18.0%（95%CI，16.8%-19.2%），退伍军人的检测率为 14.2%（95%CI，11.5%-15.0%）。在商业保险个体中，黑种人种族与较低的检测风险相关（校正风险比[aHR]，0.73；95%CI，0.58-0.91；P=.005），但在退伍军人中不相关（aHR，0.99；95%CI，0.75-1.32；P=.960）。在商业保险个体中，收入（aHR，0.90；95%CI，0.86-0.96）和净资产（aHR，0.92；95%CI，0.86-0.98）中介了种族差异，而教育（aHR，0.98；95%CI，0.94-1.01）则未中介。
患有胰腺癌、乳腺癌或转移性前列腺癌的男性中，符合指南推荐的基因检测总体完成率较低。在商业保险人群中，男性种系基因检测存在种族差异，由净资产和家庭收入介导；而在平等获得退伍军人事务部治疗的退伍军人中则不存在这种差异。减轻财务和获取障碍可能会减轻基因检测中的种族差异。
