Evidence map›Paper›PMID 41360469›Full record

Observational studyBMJ open2025

Does financial subsidy equalise cancer genetic testing uptake across socioeconomic groups? A retrospective observational study in Singapore.

Akshar Saxena, Renne Phay, Jianbang Chiang, Fuh Yong Wong, Jeanette Yuen, Diana Ishak, Sara Tasnim, Joanne Ngeow

Abstract readObservational Study
In one paragraph

Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Not Forgotten: Patient Experiences with Genetic Variant Reclassifications.medRxiv : the preprint server for health sciences · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Akshar SaxenaDivision of Economics, Nanyang Technological University, Singapore.ORCID http://orcid.org/0000-0001-8518-0466
Renne PhayCancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
Jianbang ChiangCancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
Fuh Yong WongOncology Academic Clinical Program, Duke-NUS Medical School, Singapore.
Jeanette YuenCancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
Diana IshakCancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
Sara TasnimLee Kong Chian School of Medicine (Population and Global Health), Nanyang Technological University, Singapore.
Joanne NgeowCancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore joanne.ngeow@ntu.edu.sg.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.

designRetrospective cohort study.

settingTertiary care cancer genetics service in Singapore.

participantsThe study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.

resultsReceipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56-68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18-39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57-66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.

conclusionsFinancial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.

Indexed as

Genetic TestingNeoplasmsSocial ClassAdolescentAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesSingaporeSocioeconomic FactorsYoung AdultCancer geneticsHealth EconomicsHealth EquityPreventive Health Services

Identifiers

PMID41360469
PMCPMC12684128

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.