Discussion and uptake of cancer genetic testing among sexual minorities in the US adult population.

146 Background: Cancer genetic testing (CGT) can help individuals understand their risks and make informed decisions about prevention or early detection. There is a paucity of data on CGT in sexual and gender minority populations. This study examined differences in CGT discussion and uptake among US adults by sexual orientation. Methods: We analyzed data from the 2023 National Health Interview Survey (NHIS) that used multistage probability sampling to interview adults aged ≥18 years in the US. This study included adults who reported sex assigned at birth (note NHIS does not collect data on gender identity) and self-identified as straight/heterosexual, gay/lesbian, or bisexual/other. Participants were asked whether ever having 1) discussed the possibility of getting CGT with a health provider and 2) underwent a genetic test to determine the risk of developing cancer. We compared weighted percentages using Rao-Scott Chi-square tests and performed weighted logistic regression, controlling for demographic factors and personal and family history of cancer. All analyses accounted for complex survey design and weights. Results: The unweighted sample was 29,522 (weighted sample: 258,237,552), with a median age of 47 (IQR: 32-63) years. 61.9% were White, 17.5% Hispanic, 11.8% Black, 8.8% Other; 51.2% were female; 94.0% self-identified as straight, 3.9% as bisexual/other, and 2.0% as gay/lesbian. Overall, 7.6% (95% CI: 7.3-8.0%) had discussed CGT, and 5.1% (95% CI: 4.8-5.4%) had underwent a genetic test. Compared with straight adults (7.5%, 95% CI: 7.1-7.8%), gay/lesbian (8.6%, 95% CI: 5.9-11.3%) or bisexual/other (10.3%, 95% CI: 8.0-12.6%) adults reported a higher percentage of having discussed CGT ( p < .012). After covariate adjustment, no differences in the odds of CGT discussion were found between gay/lesbian and straight adults (adjusted odds ratio [AOR] 1.20, 95% CI: 0.84-1.73) or between bisexual/other and straight adults (AOR 1.19, 95% CI: 0.90-1.57). The proportion of CGT receipt was higher in gay/lesbian (8.7%, 95% CI: 6.1-11.3%) or bisexual/other adults (7.1%, 95% CI: 5.2-8.9%) than straight adults (5.0%, 95% CI: 4.7-5.3%) ( p < .001). In the adjusted model, gay/lesbian (AOR 1.84, 95% CI: 1.30-2.61) or bisexual/other (AOR 1.38, 95% CI: 1.01-1.90) adults remained at greater odds of having had a genetic test. Additionally, female sex, higher education, and personal or family history of cancer were associated with greater odds of having discussed or underwent CGT. Conclusions: In this nationally representative sample of US adults, CGT discussion and uptake were low, suggesting the potential need to improve genetic counseling and testing while addressing observed socioeconomic gaps. Sexual minorities were more likely to undergo CGT, which may be due to their increased awareness of cancer risks. Future research is worth exploring whether CGT varies across different cancer types in these adult populations.