Association of race and ethnicity with genomic testing at a comprehensive cancer center in North Carolina.
Genomic testing, which analyzes tumor cells or circulating tumor DNA to guide cancer treatment, is increasingly used in precision oncology. However, data on racial and ethnic disparities in its use are limited. This retrospective cohort study included patients diagnosed with stage IV breast, colorectal, non-small cell lung, or prostate cancer in 2014-2019. Patients were identified from an institutional multilevel data warehouse and their data was linked to an institutional genomics database and electronic health records. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the receipt of tumor-specific genomic testing among non-Hispanic (NH) Black and NH White patients, stratified by cancer type. The linked dataset included 3,461 patients, 44.5% of whom received genomic testing. NH Black patients with prostate cancer were less likely to use genomic testing vs. NH White patients across the study period (fully adjusted OR: 0.55, 95% CI: 0.32, 0.95), as were NH Black patients diagnosed with breast cancer in 2014-2016 (OR adjusted for patient-level covariates: 0.34, 95% CI: 0.11, 0.99). No differences in testing were observed between NH Black and NH White patients with colorectal or non-small cell lung cancer, or breast cancer diagnosed in 2017-2019. Lower documented use of tumor-specific genomic testing among NH Black patients with prostate cancer across the study period underscores the need to monitor trends and address disparities in the use of emerging precision oncology technologies. Future work targeting multilevel barriers to genomic testing is a crucial next step forward.
