| Summary: | Significance & Background: A greater number of individuals meet testing criteria as germline testing guidelines expand, which can influence surgical and treatment decisions. To manage rising patient volumes and ensure timely results, advanced practice providers (APPs) are increasingly involved in ordering germline tests. Purpose: This study highlights the expanding and evolving role of APPs in germline testing for hereditary cancer syndromes. Interventions: We queried the Myriad Collaborative Research Registry (MCRR) which contains deidentified clinical, genetic, and genomic data from cancer patients tested at Myriad Genetics. We examined individuals who had germline testing ordered by one of the following provider types: AOCN, ANP, APN, APRN, ARNP, CNS, FNP, NP, NP-MSN, PA or WHNP and was reported between January 2000 - December 2024. We assessed the number of tests ordered, positive results (defined as pathogenic (P)/likely pathogenic (LP) ), cancer diagnoses, and sex assigned at birth--both overall and annually. For cancer diagnoses, we tracked the three most common cancers annually. Results: Of the 1,315,060 patients in the MCRR, 119,973 had testing ordered by the specified provider types during the designated period. Breast cancer was the most common indication for testing overall, though its proportion declined from 100% initially to 29.1% in 2024 (Fig. 1). Other frequently tested cancers included ovarian, colon, prostate and "other". Notably, the proportion of the overall cohort that were assigned male at birth (AMAB) increased from an average of 4.3% in the first decade to 14.31% over the past five years (Fig. 2). Discussion: The increase in germline testing ordered by APPs, particularly in non-breast cancers, highlights an important shift in practice patterns as awareness increases. The rising proportion of AMAB individuals undergoing testing suggests expanded awareness of hereditary cancer risk beyond traditionally female-associated cancers. Collectively, these findings suggest that evolving provider roles and patient populations will require adaptive education strategies to optimize the delivery of hereditary cancer risk assessment.
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