PS5-11-09: Increasing rates of germline genetic testing in Veterans with breast cancer

Abstract Background: Despite increasing guideline support for germline testing in breast cancer—including universal testing recommendations from the American Society of Breast Surgeons and expanded criteria from NCCN and ASCO—uptake remains low, particularly among minority and male patients. The Veteran Affairs (VA) Breast and Gynecology Oncology System of Excellence (BGSoE) established in 2022, provides sub-specialized, evidence-based, comprehensive breast cancer care to Veterans throughout the United States via telehealth including rural and ethnic minorities. BGSoE is responsible for developing and updating the VA Breast cancer pathway, which supports universal genetic testing among patients diagnosed with breast cancer at any age. BGSoE utilizes Point of Care (POC) genetic testing and refers patients to the Comprehensive Genetic Service (CGS) for additional testing and counseling when needed. Veterans with breast cancer may undergo genetic testing through BGSoE and CGS or local community care providers. We aim to evaluate rates of guideline directed genetic testing among Veterans diagnosed with breast cancer. Methods: We conducted a retrospective cohort analysis of breast cancer patients recorded in the VA national breast cancer dashboard from May 2020 to May 2025. We assessed rates of germline and somatic testing by treatment setting (VA, including BGSoE vs. community care), sex, ethnicity, and year of diagnosis. Results: Among 13,819 patients diagnosed with breast cancer, 1601 (11.6%) were male. Germline testing was performed in 1475 (10.7%) and somatic testing in 713 (5.2%). Among females 1,320 (10.8%) underwent germline testing; among males, 158 (9.9%) were tested. Among patients treated within the VA (n=5107), 810 (15.9%) underwent germline testing (722 females [15.7%], 88 males [17.4%]). Among patients treated in the community (n=3460), 263 (7.6%) received germline testing (235 females [7.5%], 28 males [7.8%]). Uptake increased annually over time: 1.1% (15/1364) in 2020-21, 3.6% (72/1974) in 2021-22, 5.4% (102/1873) in 2022-23, 8.8% (199/2255) in 2023-24, and 16.2% (1087/6713) in 2024-25. Further analysis of the Veterans who underwent genetic testing within the BGSoE revealed that 147 out of a total of 439 (33.49%) underwent genetic testing; 134/147(91%) were females and 13/147(13%) were males. 69/147 (46.94%) identified as Black or African American, and 66/147(44.9%) as White. 22/147(14.9%) identify as rural. 103/169 (60.95%) of tests ordered through BGSoE were POC testing. Conclusion: Despite guideline recommendations, rates of genetic testing among Veterans remains very low. Our data suggests that the highest testing rates of testing were among Veterans treated by the VA and lowest among Veterans treated in Community Care, though our dataset may not include all testing performed by non-VA providers. Males and Veterans treated in the community continue to be under-tested. The utilization of POC testing by BGSoE and CGS has resulted in incremental increases in genetic testing within the VA system each year and allows us to ensure veterans can undergo genetic testing in concordance with national guidelines. Additionally, POC testing and telehealth platform provides access to genetic testing for minority and rural Veterans, who often face barriers. A limitation of our study includes a lack of complete data on testing performed through Care in the Community. These data support the BGSoE’s ongoing effort to promote comprehensive breast cancer care within the VA system. Citation Format: K. Gera, S. Bushan, S. Colonna, T. Shruti, H. Moss, S. Collins, C. Menendez, M. J. Kelley, V. Passero, G. McWhirter, C. Hirsch, A. Chiba. Increasing rates of germline genetic testing in Veterans with breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-09.