Expanding access to hereditary cancer genetic testing: a quality improvement initiative of mainstreaming in a diverse urban gynecology clinic.

Most individuals with hereditary cancer syndromes remain undiagnosed and cannot benefit from cancer mitigation strategies. Mainstreaming, or the process of integrating genetic testing into routine care, can expand access, but implementation in primary care settings has proven challenging. In a quality improvement initiative, stakeholder feedback guided the development of care algorithms, patient/provider resources, and streamlined lab workflows for mainstreaming in an urban, diverse, Medicaid-predominant benign gynecology clinic. The mainstreaming initiative was launched in December 2024; over the subsequent four months, 274 consecutive patients presented for gynecologic care and 32 (11.7%) completed same-day genetic testing. This model demonstrates a feasible and scalable approach to integrating genetic testing into benign gynecology clinics serving diverse patient populations.