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Identifying disparities in germline and somatic testing for ovarian cancer

  • Marilyn Huang
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, 1121 NW 14th St, Room 345E, Miami, FL 33136, United States of America.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
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  • Priyanka Kamath
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
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  • Matthew Schlumbrecht
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
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  • Feng Miao
    Affiliations
    Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
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  • Devin Driscoll
    Affiliations
    University of Miami Miller School of Medicine, Miami, FL, United States of America
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  • Sean Oldak
    Affiliations
    University of Miami Miller School of Medicine, Miami, FL, United States of America
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  • Brian Slomovitz
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
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  • Tulay Koru-Sengul
    Affiliations
    Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
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  • Sophia George
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
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      Highlights

      • Genetic testing in a large cohort of minority women did not demonstrate discrepancy in completion of genetic testing.
      • Disparities exist between genetic and somatic testing.
      • Further investigation into lack of testing in both genetic and somatic testing among ovarian cancer patients are essential.

      Abstract

      Objective

      Germline mutations occur in approximately 25% of patients with epithelial ovarian cancers while somatic BRCA mutations are estimated at 5–7%. The objectives of this study were to determine the rate of germline and somatic testing in women with ovarian cancer and to identify disparities in testing at a comprehensive cancer center (CCC) and a safety net hospital (SNH).

      Methods

      Patients treated for ovarian cancer from 2011 to 2016 were included. Clinicopathologic data were abstracted from the electronic medical records. Logistic regression modeling were performed to calculate odds ratios (OR) and corresponding 95% confidence intervals (95%CI).

      Results

      Out of 367 women, 55.3% completed germline testing; 27.0% received somatic testing. Women at the CCC were more likely to be tested for germline (60.4% vs 38.1%, p ≤ 0.001) and somatic (34.3% vs 2.4%, p ≤ 0.001) mutations than those at the SNH. Patients with Medicare (aOR = 0.51, 95%CI 0.28–0.94, p = 0.032) or Medicaid (aOR = 0.42, 95%CI 0.18–0.99, p = 0.048) were less likely to receive germline testing than those privately insured. Patients with Medicaid were less likely to receive somatic testing (aOR = 0.15, 95%CI 0.04–0.62, p= 0.009) than those privately insured. Women with disease recurrence had a higher likelihood of being tested for germline (OR = 3.64, 95%CI 1.94–6.83, P < 0.001) and somatic (OR = 7.89, 95%CI 3.41–18.23, p < 0.001) mutations. There was no difference in germline or somatic testing by race/ethnicity.

      Conclusions

      Disparities in both germline and somatic testing exist. Understanding and overcoming barriers to testing may improve cancer-related mortality by allowing for more tailored treatments as well as for improved cascade testing.
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