• Many young breast cancer survivors are interested in CHIP testing, with preferences varying by risk communication and actionability

  • Learning of CHIP and associated risks may elicit significant anxiety requiring provider awareness and specific care

Clonal hematopoiesis of indeterminate potential (CHIP), an emerging biomarker for personalized risk-directed interventions, has increased prevalence in cancer survivors. Little is known about patients' preferences regarding CHIP testing. We surveyed participants in an ongoing prospective cohort study of young women with breast cancer (BC). The emailed survey included an introduction to CHIP and a clinical vignette eliciting participants' preferences for CHIP testing considering sequentially: 1) population-based 10-year risk of BC recurrence, hematological malignancy and heart disease; 2) increased CHIP-associated risks; 3) current CHIP management; 4) dedicated CHIP clinic; 5) hypothetical CHIP treatment. Preference changes were evaluated with McNemar's test. Survey response rate was 82.2%(528/642). Median age at survey was 46 years (range: 31-54), time from diagnosis 108 months (range: 60-168). Only 5.9% had prior knowledge of CHIP. After vignette presentation, most survivors (87.1%) recommended CHIP testing for the vignette patient. Presented next with CHIP-independent, population-based risks, 11.1% shifted their preference from testing to not testing (p<0.001). After information about CHIP-associated risks, an additional 10.1% shifted preference to testing (p<0.001). Preference for testing (p<0.001) increased if vignette patient was offered a CHIP clinic or hypothetical CHIP treatment, with 7.2% and 14.1% switching preferences towards testing, respectively. Finally, 75.8% desired CHIP testing for themselves. 28.2% reported learning about CHIP caused at least moderate anxiety. Most young survivors favored CHIP testing with preferences influenced by risk presentation and potential management strategies. Our findings highlight the importance of effective risk communication and adequate psychosocial support when considering biomarkers of future risks in cancer survivors. This trial is registered at www.clinicaltrials.gov as NCT01468246.

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