Racial disparities in molecular testing among patients with early-onset metastatic pancreatic ductal adenocarcinoma.

Abstract

e13752 Background: Germline and somatic genetic testing are considered standard of care for patients with pancreatic ductal adenocarcinoma (PDAC) per NCCN guidelines. Early-onset PDAC in particular has a higher likelihood of an underlying hereditary predisposition, warranting genetic evaluation as part of the diagnostic workup to inform therapeutic selection, clinical trial eligibility, and familial risk assessment. However, disparities in access to and completion of molecular testing among patients with early-onset PDAC remain understudied. Methods: We conducted a retrospective cohort study of all patients diagnosed with early-onset PDAC with metastatic disease between January 2015 and December 2025 at a single academic center. Patients were identified using ICD-10 codes, with pathologically confirmed PDAC and documented staging. Clinical, demographic, molecular, and treatment data were abstracted from the electronic health record and entered into a secure REDCap database. The primary outcomes were completion of germline and somatic tumor testing. Results: Among 95 patients with early-onset metastatic PDAC, black patients demonstrated substantially lower rates of molecular testing compared with non-black patients. Germline testing was completed in 20.0% of black patients versus 67.8% of non-black patients (OR 0.12; Fisher’s exact p = 0.048). Somatic tumor testing was also less frequent among black patients (20.0% vs 66.7%; OR 0.13; Fisher’s exact p = 0.054). When considering either germline or somatic testing, black patients were less likely to receive any molecular testing compared with non-black patients (40.0% vs 78.9%; OR 0.18; Fisher’s exact p = 0.080). Notably, no black patients received both germline and somatic testing compared with 55.6% of non-black patients (0% vs 55.6%; Fisher’s exact p = 0.021), highlighting a significant disparity in completion of comprehensive precision oncology evaluation. Conclusions: Despite NCCN guideline recommendations, black patients experienced significantly lower completion of comprehensive molecular testing in early-onset metastatic PDAC, suggesting potential gaps in delivery of precision oncology care. Although limited by sample size, these findings support efforts to standardize and more equitably deliver molecular testing for patients with early-onset PDAC. Molecular testing for early-onset pancreatic ductal adenocarcinoma, stratified by race. Race N Germline testing (%) Somatic testing (%) Both (%) White 39 69.2% 71.8% 59.0% Asian 25 52.0% 68.0% 52.0% Hispanic/Latinx 16 75.0% 50.0% 50.0% Black 5 20.0% 20.0% 0% Other 9 88.9% 77.8% 66.7%