Clinician Discussion of Family Cancer Risk and Use of Genetic Testing Among US Adults With a Family History of Cancer

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Of 29,522 adult survey respondents to the 2023 National Health Interview Survey, 17,741 were excluded: 15,960 were without family cancer history and 1,781 were missing data (ranging from 0.02% to 6.5%). Missing data included the following categories: family cancer history (n = 820), race (n = 408), self-reported severe difficulty or inability to remember/concentrate (n = 375), clinician discussion (n = 44), education level (n = 33), genetic testing (n = 32), age (n = 20), number of urgent care visits in the past 12 months (n = 16), self-reported personal cancer history (n = 13), health insurance (n= 11), usual place of care (n = 7), and sex (n = 2). This process yielded 11,781 adults in the analysis cohort. Of these, 5,464 (45%) had family cancer history and clinician discussion, and 6,317 (55%) had family cancer history and no clinician discussion. PS matching and 1:1 greedy nearest-neighbor PS matching without replacement was conducted. The result was 9,476 PS–matched cohort (unweighted) with an exact match on age, sex, race, education level, rural/urban; health insurance, usual place of care; number of times visited urgent care past 12 months; and personal cancer history. Finally, 4,738 (50%) were in the group with family cancer history and clinician discussion, and 4,738 (50%) were in the group with family cancer history and no clinician discussion.

Figure. Flow diagram for a study on clinician discussion of family cancer risk and use of genetic testing among US adults with a family history of cancer. The PS matched cohort (unweighted n = 9,476) represented 72.6 million US adults. Percentages account for the complex survey design by incorporating strata, primary sampling units, and sampling weights. Abbreviation: PS, propensity score. Data source: 2023 National Health Information Survey (13).

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