Population-based analysis of cancer disparities and social determinants of health in hereditary cancer syndrome carriers: A Healthy Nevada Project study.

Abstract

10616 Background: Hereditary cancer syndromes account for approximately 5-10% of all cancers, the most common being Hereditary Breast and Ovarian Cancer (HBOC) and Lynch Syndrome (LS). Despite the availability of genetic testing that can reduce cancer morbidity and mortality in carriers, significant disparities exist across various socioeconomic and racial groups. Methods: This retrospective cohort study analyzed participants from the Healthy Nevada Project (HNP) who underwent genetic testing for hereditary cancer syndromes. A study protocol was developed by the research committee prior to implementation. Participants were classified as positive or negative for HBOC syndrome (BRCA1/2 pathogenic variants) and Lynch syndrome (mismatch repair gene pathogenic variants). Race, age and ethnicity were categorized along with census tract-level social determinants of health (SDOH) measures including median household income and percent rural population. Descriptive statistics characterized the cohort by demographic and clinical variables. Associations between SDOH and cancer outcomes including diagnosis and age at diagnosis, were assessed using chi-square and logistic regression analysis to test for significance. Multivariable logistic regression models were constructed to assess independent associations between SDOH factors and cancer outcomes, adjusting for confounding variables. Results: A total of 47,737 patients were identified using the HNP database. Genetic testing occurred after cancer diagnosis in 99.6% of participants with cancer (2,542/2,552). Delays differed significantly across racial groups (p<0.001). There were no significant bivariate nor multivariate associations between HBOC and gender (p=0.63;0.61), race (p=0.52;0.70), Ethnicity (p=0.36;0.67), income (p=0.75;0.88) or rurality (p=0.52; 0.63). In multivariable logistic regression, younger age at testing was independently associated with genetic test positivity (OR 0.993 per year; 95% CI 0.988–0.999; p=0.014). Conclusions: Population-based studies examining the intersection of hereditary cancer syndromes and SDOH remain limited, particularly in diverse cohorts that reflect real-world demographics. The absence of differences in pathogenic variant prevalence across sociodemographic groups suggests that population-based genetic screening may mitigate traditional disparities in genetic yield. However, observed differences in age at testing indicate persistent inequities in timing of access, which may influence early cancer detection. In fact, delayed post-diagnosis genetic evaluation is common across all SDOH groups in this cohort. Understanding these relationships is essential for developing equitable cancer prevention and control strategies that address both genetic predisposition and the social context in which carriers live.