Socioeconomic and Clinical Determinants Driving Access to BRCA Genetic Testing in Cancer : A Case-Control Study Using
Medrxiv : the Preprint Server for Health Sciences
|June 4, 2026
Summary
Social determinants of health significantly impact BRCA genetic testing rates in cancer patients. Addressing socioeconomic barriers is crucial for improving equitable access to this vital cancer screening.
Area of Science:
- Oncology
- Genetics
- Public Health
- Health Disparities
Background:
- BRCA genetic testing is essential for cancer risk assessment and personalized treatment.
- Underutilization of BRCA testing persists, potentially due to socioeconomic and clinical factors.
- Identifying drivers of testing uptake is key to improving access and cancer outcomes.
Purpose of the Study:
- To quantify the effects of social determinants of health (SDoH) on BRCA genetic testing.
- To develop a predictive model for identifying patients at risk of underutilizing BRCA testing.
- To investigate SDoH in individuals with breast, ovarian, pancreatic, and prostate cancers.
Main Methods:
- Observational case-control study using a large multistate clinical research data network (2012-2023).
- Linked patient records with ZIP code-level SDoH variables.
- Included adults diagnosed with breast, ovarian, pancreatic, or prostate cancer (cases: received testing; controls: did not).
Main Results:
- Higher education, public-sector employment, neighborhood safety, and social participation increased BRCA testing likelihood.
- Economic instability (housing cost burden, public insurance reliance) reduced testing uptake.
- A predictive model showed good discrimination (AUROC, 0.776), with nativity, language, and residential stability as key predictors.
Conclusions:
- SDoH are strongly associated with BRCA genetic testing receipt among cancer patients.
- Disparities in testing likely reflect structural and social barriers, not just clinical eligibility.
- Integrating SDoH into clinical workflows and targeted outreach can improve equitable access to genetic testing.
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