Incidence of germline genetic testing in Veterans with breast cancer in the Veterans Health Administration.

e13531 Background: The Department of Veterans Affairs (VA) has seen a 3-fold increase in breast cancer (BC) diagnoses in recent decades, 90% of which occur in women Veterans. While technological and biomedical advances have increased the availability and actionability of germline genetic testing (GGT), adoption in practice has been slow. The VA National Oncology Program (NOP) recommends that all Veterans with BC be offered GGT. The Making Advances in Mammography and Medical Options for Veterans Act of 2022 mandated that the VA perform a study of GGT in Veterans with BC, the initial results of which are reported here. Methods: Veterans diagnosed with BC between Jan 1, 2021 and Dec 31, 2022 were identified in the VA Cancer Registry System (VACRS) using site code C50 and excluding histology codes 95903, 96803, and 96993. Of those, Veterans receiving care for BC in the VA were defined as those having at least 2 visits within a year with VA hematology, oncology, radiation oncology, or surgery with codes C50.x, D05.x, Z17.x, Z19.x, or Z85.x. We retrieved clinical notes from these visits and used natural language processing (named entity recognition, entity linking) to identify and highlight relevant concepts to expedite chart review. We randomly selected 200 Veterans, loading their notes into a custom-designed chart review application. A team of 5 clinical subject-matter experts reviewed these notes for evidence of GGT. Each Veteran’s notes were reviewed independently by 2 reviewers. Disagreements were adjudicated by the whole team. Results: 1505 Veterans met diagnostic criteria in VACRS; of these, 1201 met utilization criteria and constituted the study population. Table summarizes demographic characteristics. Inter-annotator agreement was 85.5%. Of the 200 Veterans whose charts were reviewed, 118 (59%) were offered testing, referred to a genetic counseling service, or otherwise had evidence of testing found upon chart review, while 61 (31%) had no such evidence. Ten patients (5%) were deemed ineligible for GGT based on practice guidelines at the time, and chart review found that 11 (6%) had no evidence of clinical care within the VA. Among 189 seen by a VA oncology clinician, 118 (62.4%) had or were offered genetic services. Conclusions: Most Veterans with breast cancer are offered germline genetic testing. Future work will evaluate ongoing efforts to improve adherence to VA NOP guidelines to ensure that every Veteran with breast cancer can access germline genetic testing. Table: see text