Hereditary Cancer Awareness Week 2026: What We’re Learning About Cascade Testing!

Megan Dwyer, MS, CGC, CGA-IGC Communications Committee member

National Hereditary Cancer Week takes place from September 27 to October 3, with a focus on raising awareness of inherited cancer risk and promoting early detection through genetic testing and screening. A central part of this effort is cascade testing: testing family members after a cancer-related gene mutation is identified in a relative. Done well, it catches at-risk individuals before cancer develops, enabling earlier surveillance and better outcomes. Two recent studies, Kurian et al. (2026) and Namey et al. (2026), help explain why cascade testing still falls short in practice.

The core problem: talk doesn't equal action

Kurian et al. (2026) surveyed cancer patients and found they're motivated: most understood their results well enough to share them, felt responsible for doing so, and told the majority of their first-degree relatives. But nearly a third reported that no relatives ultimately got tested. Namey et al. (2026), analyzing lab testing records rather than patient surveys, found the same gap from a different angle: only 24% of probands with a hereditary cancer variant had even one relative complete testing. Together, the studies suggest the problem isn't that patients won't share results, it's that sharing doesn't reliably lead to relatives testing.

What moves the needle, and what doesn't

The two studies diverge in an interesting way. Kurian et al. (2026) found patient attitudes and communication were consistent across gene type and demographics. Namey et al. (2026), however, found that cascade testing uptake varied significantly by race and ethnicity, with significantly lower rates of testing for African American or Black, Asian, Hispanic, and Middle Eastern probands compared to non-Hispanic White probands, even after controlling for socioeconomic status.

Both studies agree that cost isn't the main driver. Namey et al. (2026) found that free cascade testing didn’t increase testing uptake, nor did it close racial gaps, pointing instead to clinical and cultural factors—such as provider bandwidth and knowledge, fear of genetic discrimination, and distrust in the medical system—playing a larger role than financial barriers.

The role of clinicians in cascade testing

Both studies found that genetic counselor involvement improved outcomes, whether measured by patient communication or actual testing. But even in genetic counselor-involved cases, most relatives still weren't tested, and few clinicians reached out to relatives directly.

A shortage of genetic counselors, combined with the importance of genetic results for treatment, has prompted more medical oncologists, surgeons, and advanced practice providers to initiate germline testing themselves. This shift has limits, however. Namey et al. (2026) found that few medical oncologists and surgeons were involved in discussions about cascade testing, likely reflecting competing clinical priorities and limited genetics training.

Takeaway: Across both studies, cascade testing fails less because people don't want to test, and more because the system doesn't support the "last mile," turning a patient's willingness to share results into a relative's completed test. Closing that gap, especially for underserved populations, will likely require more structured clinician involvement and better tools for ongoing family communication.

The cascade testing blog post is accompanied by a practical, one-page infographic created by Communications Committee Chair Michelle Springer, MS, CGC, highlighting resources that healthcare providers can share with patients and families to support genetic testing, family communication and access to support.  Explore the infographic HERE and save it for easy reference.

1. Namey, E., Horton, C., Dudley, B., Carraway, C., Komala, T., Milliard, C., Namey, T., Karloski, E., & Brand, R. (2026). Differences in Cascade Genetic Testing Among Families With Hereditary Cancer Risk. JAMA network open, 9(6), e2621242. https://doi.org/10.1001/jamanetworkopen.2026.21242

2. Kurian, A. W., Abrahamse, P., Furgal, A., Veenstra, C. M., Courser, R. R., Hofer, T. P., Hodan, R., Caswell-Jin, J. L., Gomez, S. L., Ward, K. C., Hamilton, A. S., Liu, L., An, L. C., & Katz, S. J. (2026). Communication With Clinicians and Relatives About Cascade Genetic Testing in Cancer Patients With Germline Pathogenic Variants. JCO precision oncology, 10(6), e2600041. https://doi.org/10.1200/PO-26-00041

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