Background: Genetic and genomic testing are increasingly recognized as essential to high quality cancer care. Despite expanded eligibility for testing in recent years, barriers to genomic medicine persist. Notably, growing political and social mistrust risks negatively impacting views of medical institutions, medical professionals and complex technologies, and could undermine acceptance of genetic/genomic testing to guide treatment and identify risk in families. Prior studies have documented disparities and increased MM of genetic counseling and testing among underserved minorities which have been associated with delays or avoidance to care. We sought to identify individual characteristics associated with MM among cancer patients. Methods: A cross-sectional survey of cancer pts from the Fox Chase Cancer Center (FCCC) Burholme Campus (n=105, mixed urban/suburban, primarily insured) and Broad street campus (n=95, primarily urban underserved population) was conducted from 6/22-12/22, using a maximum variation (purposeful) sampling approach. Surveys queried MM using the LaVeist MM Index (MMI, range 0-10, measures healthcare/institution MM) and the Thompson Group Based MM Scale (GBMMS, range 1-5, measures race/ethnic specific MM; suspicion, discrimination, and lack of support subscales). Demographic and disease factors, as well as psychosocial measures (general/genetic health literacy, social support, self-advocacy, conspiratorial thinking, relationship with doctor, and trust in information sources) were also assessed. Medical decision making preference and health literacy were assessed with single validated items. The study was approved by the FCCC IRB #22-8003. Results: Participants had a median age of 62 yrs (range 25-91); 62% were female, 47% African American (AA), 15% Hispanic, 42% married, 47% high school graduate or less, 52% had household income <$50K/yr. Breast (28%), colorectal (16%), and GYN/GU (12%) cancers were the most commonly reported, and 23% reported >1 previous cancer diagnosis. Mean GBMMS was 2.11 (SD 0.80) and mean MMI was 4.63 (SD 1.54). See the table for significant associations. Conclusions: High levels of healthcare institution and race-based MM are associated with socio-demographic vulnerabilities, putting the most vulnerable cancer patients at high risk of making poor health decisions.