BRIDGe: Barriers to real-world implementation of diagnostic genomics—Quantifying the genomic awareness-access divide in Indian oncology care.

Abstract

e13604 Background: Uptake and actionability of molecular testing remain suboptimal in low-and-middle-income settings. In this study, we quantify the awareness-to-uptake gap & care-delivery gaps, identifying modifiable barriers to equitable precision oncology, in an urban tertiary oncology center in South India. Methods: Cross-sectional, anonymized survey (Cronbach’s α = 0.7) developed by a 4-member oncology team and piloted in the OPD, conducted between January & December 2025. Along with clinical data, a 7-item factual genomic awareness score (range 0–7; ≥5 = high awareness) assessed knowledge of clinical utility, heritability, methods, facilities and access. Uptake was defined as completion of molecular test. Descriptive statistics and Chi Square were done to identify predictors of test uptake. Results: Participants included 114 patients and 314 caregivers (73.4%); 67.3% were female and 15.8% were medical personnel. Respondents were primarily affiliated with breast (47.6%), gastrointestinal (17.3%) and gynecological (16.8%) cancers. Per indication, 276 respondents underwent pre-test counselling, and only 178 actually underwent molecular testing. Among them, 39.3% were covered by insurance, 32.6% paid out-of-pocket and only 28.1% could utilize patient-assistance. Treatment was modified in 50.6% based on results; while 88/178 (49.4%) had no treatment change (46 with no actionable result; 42 were financially unable to access indicated therapy). Initial exposure to genomic testing was predominantly physician-driven. Despite 73.4% knowing that cancers can be inherited, only 216 respondents identified the role of molecular testing in guiding diagnosis and treatment. Despite high interest (81.8% wished to learn more; 74.8% willing to participate in research), 92.8% perceived testing as unaffordable and only 7.0% were aware of possible insurance coverage. Barriers to testing included lack of awareness (65.0%), cost (25.2%), fear of results (9.8%). 35.5% reported ethical/privacy concerns. Despite an urban/graduate majority, only 24.8% met the criteria for high awareness (Age < 40y, Post graduate education, caregivers, medical background p < 0.05). Mean awareness scores were higher among those tested (4.8±1.5) than the overall population (3.3±1.6). Conversely, high awareness did not translate to high test uptake (p < 0.05). Medical background and postgraduate education were independent predictors of test uptake. (p < 0.05). Conclusions: Despite a tertiary-urban setting, genomic literacy is moderate. Willingness and meaningful clinical impact are undermined by affordability and limited insurance coverage. In LMICs, precision oncology cannot be equitable if genomic awareness outpaces financial and systemic support. Improvement of public education & healthcare policy advocacy can bridge the awareness-to-uptake divide in cancer care.