# Implementation of a Traceback Testing Program for Ovarian Cancer: Findings from the FACTS Study

## TL;DR

A traceback testing program for ovarian cancer identified eligible patients and offered genetic testing, but no at-risk relatives received testing despite support.

## Contribution

The study evaluates the implementation and outcomes of a traceback testing program in three U.S. health systems.

## Key findings

- 59% of eligible patients were successfully contacted, and 38% of those completed genetic testing.
- 8% of tested individuals had results indicating increased cancer risk, but no at-risk relatives underwent cascade testing.
- Participants and staff found the program important, but the resource demands may affect long-term success.

## Abstract

Genetic testing can help people with cancer and their families. Traceback testing finds people with cancer who missed genetic testing at diagnosis and offers it to them. We studied a Traceback program in three U.S. health systems. We identified 597 eligible patients and reached 59% of them. Of those reached, 133 (38%) completed genetic testing. Ten people (8% of those tested) had results that indicated increased cancer risks. However, no at-risk relatives completed free testing, despite reminders and support. Participants and staff thought that the program was important, but the extra work to accurately identify people who are eligible for Traceback testing could limit long-term success. Overall, the program found and reached people who were eligible for Traceback testing, but no at-risk relatives received testing during the study. Future studies can explore the program’s potential.

Background: Traceback testing—identifying and offering testing to people with previous cancer diagnoses who have not received current standard genetic testing—could benefit patients and their at-risk relatives. Methods: We conducted a multisite, nonrandomized pilot implementation study of a Traceback program at three integrated United States health systems. We assessed the reach, fidelity, effectiveness, and acceptability of the program using quantitative and qualitative methods. Results: We identified 597 eligible individuals using administrative data and manual chart review. We attempted to reach everyone identified (100% fidelity). We successfully contacted 354 people, for a reach of 59% of confirmed eligible individuals. In total, 133 people completed Traceback genetic testing. Ten of these (8%) received pathogenic or likely pathogenic results;. Nine of these ten people received positive results for which cascade testing of at-risk relatives would be indicated. None of their relatives underwent cascade testing during the study period. Thirty-six received variants of uncertain significance (VUS). Traceback programs were acceptable to participants and implementers and thought to be applicable to other genetic screening conditions. The time and resources required to accurately identify Traceback-eligible individuals are likely determinants of future sustainability. Conclusions: Education about free cascade testing, reminder calls to probands, and offers to directly contact at-risk relatives did not result in cascade testing in this pilot study. However, participant and implementer discussions suggest that the potential benefits of Traceback programs and high participant acceptability are worthy of further study.