Clinician Recommendation for Hereditary Genetic Testing in Participants at Increased Risk for Hereditary Cancer

Background: Despite clinical utility in managing hereditary cancers, genetic testing (GT) remains underutilized. While barriers include knowledge gaps and cost, clinician recommendation is a major driver of GT uptake, with rates varying by cancer type and family cancer history documentation. Methods: Adult participants (≥18 years) were recruited through multiple sources to complete a cancer family history survey for a larger intervention trial. Participants with personal or family history indicating increased hereditary cancer risk who had not undergone GT (N = 3001) were invited to complete a baseline survey. Multivariable logistic regression was used to analyze associations between demographics and cancer history by receipt of a clinician recommendation for GT. Results: Among 784 respondents, most were White (84.6%), female (58.4%), and over age 51 (75.3%), with 58.2% reporting a diagnosis of cancer. Only 14.0% reported receiving a clinician recommendation for GT, with lower recommendation rates among younger adults (20.1%), those reporting no financial stress (10.7%), and those with higher education (12.0%). Multivariate analysis showed participants who did not report financial stress (p = 0.049) were less likely to receive a recommendation. Discussion: These findings highlight disparities in GT recommendation by clinicians. Increased clinician education about indications for GT, the implementation of electronic medical record tools to facilitate the identification of patients with guideline-concordant personal and/or biological-relative cancer history, and patient-facing interventions could standardize the dissemination of recommendations for GT. Conclusions: Future efforts that focus on increasing clinician education and electronic decision support should identify individuals with personal and/or biological-relative cancer history meeting criteria for GT.