{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:42:48Z","timestamp":1792194168942,"version":"4.4.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,7,3]]},"abstract":"<jats:sec id=\"ab-joi230066-4\"><jats:title>Importance<\/jats:title><jats:p>Germline genetic testing is recommended by practice guidelines for patients diagnosed with cancer to enable genetically targeted treatment and identify relatives who may benefit from personalized cancer screening and prevention.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230066-5\"><jats:title>Objective<\/jats:title><jats:p>To describe the prevalence of germline genetic testing among patients diagnosed with cancer in California and Georgia between 2013 and 2019.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230066-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Observational study including patients aged 20 years or older who had been diagnosed with any type of cancer between January 1, 2013, and March 31, 2019, that was reported to statewide Surveillance, Epidemiology, and End Results registries in California and Georgia. These patients were linked to genetic testing results from 4 laboratories that performed most germline testing for California and Georgia.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230066-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was germline genetic testing within 2 years of a cancer diagnosis. Testing trends were analyzed with logistic regression modeling. The results of sequencing each gene, including variants associated with increased cancer risk (pathogenic results) and variants whose cancer risk association was unknown (uncertain results), were evaluated. The genes were categorized according to their primary cancer association, including breast or ovarian, gastrointestinal, and other, and whether practice guidelines recommended germline testing.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230066-8\"><jats:title>Results<\/jats:title><jats:p>Among 1\u202f369\u202f602 patients diagnosed with cancer between 2013 and 2019 in California and Georgia, 93\u202f052 (6.8%) underwent germline testing through March 31, 2021. The proportion of patients tested varied by cancer type: male breast (50%), ovarian (38.6%), female breast (26%), multiple (7.5%), endometrial (6.4%), pancreatic (5.6%), colorectal (5.6%), prostate (1.1%), and lung (0.3%). In a logistic regression model, compared with the 31% (95% CI, 30%-31%) of non-Hispanic White patients with male breast cancer, female breast cancer, or ovarian cancer who underwent testing, patients of other races and ethnicities underwent testing less often: 22% (95% CI, 21%-22%) of Asian patients, 25% (95% CI, 24%-25%) of Black patients, and 23% (95% CI, 23%-23%) of Hispanic patients (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001 using the \u03c7<jats:sup>2<\/jats:sup> test). Of all pathogenic results, 67.5% to 94.9% of variants were identified in genes for which practice guidelines recommend testing and 68.3% to 83.8% of variants were identified in genes associated with the diagnosed cancer type.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230066-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Among patients diagnosed with cancer in California and Georgia between 2013 and 2019, only 6.8% underwent germline genetic testing. Compared with non-Hispanic White patients, rates of testing were lower among Asian, Black, and Hispanic patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2023.9526","type":"journal-article","created":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T20:30:38Z","timestamp":1685997038000},"page":"43","source":"Crossref","is-referenced-by-count":171,"title":["Germline Genetic Testing After Cancer Diagnosis"],"prefix":"10.1001","volume":"330","author":[{"given":"Allison W.","family":"Kurian","sequence":"first","affiliation":[{"name":"Department of Medicine, School of Medicine, Stanford University, Stanford, California"},{"name":"Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Abrahamse","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, School of Public Health, University of Michigan, Ann 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Pediatrics, School of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Tocco","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor"},{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Berek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily","family":"Hoang","sequence":"additional","affiliation":[{"name":"Ambry Genetics, Aliso Viejo, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Yussuf","sequence":"additional","affiliation":[{"name":"Ambry Genetics, Aliso Viejo, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Susswein","sequence":"additional","affiliation":[{"name":"GeneDx, Gaithersburg, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward D.","family":"Esplin","sequence":"additional","affiliation":[{"name":"Invitae, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas P.","family":"Slavin","sequence":"additional","affiliation":[{"name":"Myriad Genetics, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scarlett 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