Abstract C026: Cancer history and rural residence as determinants of genetic cancer risk testing engagement among U.S. adults

Abstract

Cancer genetic testing for inherited cancer risks has gained increasing recognition as a valuable risk assessment and personalized screening tool for individuals with personal or family cancer histories. Persistent disparities in genetic testing engagement have been documented across different study settings, especially with rural communities. However, how personal cancer history and rural residence interact to influence testing engagement is largely unknown. Here, we examined the association between level of cancer genetic testing engagement with personal cancer history and rurality among U.S. adults aged 18 years and older. We conducted a cross-sectional study using data acquired from the 2023 National Health Interview Survey (NHIS). The primary outcome of interest is cancer genetic testing engagement, categorized into four groups: (1) both a genetic testing discussion with the provider and genetic test uptake, (2) uptake only, (3) discussion only, and (4) neither. Self-reported personal history of cancers (yes or no), alongside a three-level rurality classification (urban, suburban, rural), serve as the main exposure. Weighed adjusted multinomial logistic regression models were performed. Of the 27,558 eligible adults, 90.5% reported no genetic testing engagement, while only 3.3% reported both discussion and uptake. Among adults who reported both discussion and uptake, 32.8% had a cancer history, whereas among those with no engagement, 91.5% did not have a cancer history (p < 0.001). Rural residents had the highest proportion reporting no engagement, suburban residents discussion only, and urban residents both discussion and uptake (p=0.001). In the adjusted model, adults with a personal cancer history had fivefold higher odds of engaging in both genetic testing activities than those without a cancer history (OR = 5.08; 95% CI: 4.19–6.15). Rural residence was significantly associated with lower odds of having both engagements (OR, 0.78; 95% CI, 0.62-0.98) and having uptake only (OR, 0.69; 95% CI, 0.48-0.97), compared to urban residents. Interaction between personal cancer history and rurality is observed (p=0.005). Our stratified analysis showed that rural participants with a personal cancer history were more likely to have genetic testing uptake by 4.1 times (OR, 4.10; 95% CI, 2.21-7.60) compared to those without a history of cancer. Among urban (OR = 4.95, 95% CI: 3.80–6.44) and suburban (OR = 4.95, 95% CI: 3.47–7.06) residents, individuals with a personal history of cancer were nearly five times more likely to engage in both discussions and uptake than those without a cancer history. Genetic testing engagement was low overall and disproportionately lower among rural residents. Personal cancer history was consistently the strongest predictor of engagement, though its effect was smaller among rural residents than among urban/suburban residents. Future research should explore what drives the persistent rural-urban gap in engagement to inform targeted strategies for improving equitable access. Dongyu Zhang, Minjee Lee, Yue Guan, Steven Coughlin, Meng-Han Tsai. Cancer history and rural residence as determinants of genetic cancer risk testing engagement among U.S. adults [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C026.