Rethinking risk: Disparities and genetic testing outcomes from a novel public-facing cancer prevention program.

Abstract

e13607 Background: Identifying individuals at high risk for cancer is central to effective prevention and early detection. We evaluated outcomes from a novel public-facing cancer prevention program designed to broaden engagement beyond traditional referral-based models. Methods: The Hennessy Institute, a cancer risk assessment, early detection, and prevention program at Hackensack Meridian Health, launched in July 2024. Data was retrospectively analyzed through January 2026. A multi-faceted outreach strategy guided individuals to an online assessment of personal and family cancer history identifying participants as "high risk" if they met NCCN criteria for genetic testing (HBOC, Lynch, or polyposis), high risk breast screening, or lung cancer screening. Participants interested in learning more were contacted by a trained nurse navigator to review their assessment results. Genetic testing was offered regardless of guideline criteria. Results: Among 4,680 individuals screened, the majority were female (84%). 1,035 reported ethnicity/ race including: 62% White Non-Hispanic, 20% Hispanic, 9% Black, 7% Asian, and 2% other. In total, 53% of individuals were deemed high risk, meeting at least one of the following criteria: genetic risk (45%), high-risk breast (19%), or high-risk lung (8%). Significant ethnic disparities were found in risk status, with a higher proportion of White and Non-Hispanic subjects being classified as high-risk compared to Non-White and Hispanic subjects. Overall, 39% expressed interest in learning more and agreed to be contacted for follow-up; interest was higher among high-risk compared to average-risk individuals (43% vs 34%, p < 0.001), while age was not associated with interest. Among 332 individuals who completed genetic testing, 49 tested positive for pathogenic/ likely pathogenic variants (15%). Mutation positivity rates did not significantly differ between individuals meeting NCCN criteria and those who did not (15% vs 13%, p = 0.59). Conclusions: This real-world analysis from a public cancer prevention program revealed significant ethnic disparities in risk stratification and a greater than expected mutation positivity rate within a general population cohort. These findings suggest restricting genetic testing to guideline-defined populations may miss clinically meaningful cancer risk and highlight the need to evaluate broader genetic screening strategies. Group Analyzed (mean) t Stat P(T≤ t) one-tail P(T≤ t) two-tail High Risk Rate White (57%) vs. High Risk Rate Non-White (42%) ** -4.85664 0.0000007 0.0000014 High Risk Rate Hispanic (44%) vs. High Risk Rate Non-Hispanic (54%)* 2.59568 0.0047870 0.0095740 Interest Rate Average Risk (34%) vs Interest Rate High Risk (43%)** -5.71185 0.0000000 0.0000000 Positivity Average Risk (13%) vs Positivity met NCCN criteria (15%) -0.54341 0.0292575 0.585151 *Significant p < 0.01. **Significant p < 0.001.