Disparities in germline genetic testing in gastrointestinal malignancies by language preference.

222 Background: Gastrointestinal (GI) cancers account for nearly 20% of all cancers in the United States (US), with colorectal (CRC) and pancreatic cancers as leading causes of cancer-related deaths. While most GI cancer cases are sporadic, a significant subset are linked to inherited mutations that increases a person’s risk of cancer. Early identification of pathogenic germline variants is critical for informing personalized surveillance and preventive strategies, guiding cascade testing, and optimizing targeted therapies. Over 25 million people in the US have limited English proficiency (LEP), a population known to experience worse cancer care outcomes. Less is known whether disparities in germline testing uptake exist by language preference amongst patients with GI cancers. Methods: We conducted an IRB-approved retrospective study from 2019 to 2024, at a single academic center, including patients aged ≥18 years with GI cancers (pancreatic, gastric, or CRC) who met criteria for germline genetic testing (age < 50, MSI-H status, or suspected pathogenic mutations on tumor NGS). We evaluated if language preference (English vs Non-English) was associated with genetic testing uptake. We used logistic regressions to calculate odds ratios adjusting for age, gender, race/ethnicity, and insurance. Results: A total of 4,584 patients with GI cancers were included in the analysis. Of the 2,907 patients with pancreatic cancer, median age was 69, most were male (n = 1490, 51.3%), Non-Hispanc White (NHW) (n = 2104, 72.4%) and on Medicare/Medicaid (n = 1925, 66.3%). Of the 195 patients with gastric cancer, median age was 43, most were male (n = 107, 54.8%), NHW (n = 109, 55.9%) and on private insurance (n = 132, 67.7%). Of the 1,482 patients with CRC, median age was 44, most were female (n = 746, 51%), NHW (n = 912, 61.5%) and on private insurance (n = 1079, 72.8%). Among all 4,584 patients, 971 (21.2%) underwent germline genetic testing. Testing completion rates varied by cancer type: pancreatic (19.7%), gastric (20%), and colorectal (24.3%). For patients diagnosed with pancreatic or colorectal cancer, non-English speaking patients had lower odds of completing testing compared to English speaking patients (see Table 1). Conclusions: This study shows that, despite guideline recommendations, germline genetic testing rates are critically low among patients with pancreatic, gastric, and colorectal cancer. Disparities in genetic testing uptake exist among LEP patients. Targeted interventions are urgently needed to improve genetic testing uptake, especially among this vulnerable population. Odds ratio for genetic testing completion among non-English speakers compared to English-speakers. Cancer Type Language Genetic TestingOdd Ratio (95% CI) Pancreatic English Ref Non-English 0.55 (0.33-0.94) Gastric English Ref Non-English 0.88 (0.21-3.78) Colorectal English Ref Non-English 0.35 (0.14-0.87)