George Kumar, Senior Director at AstraZeneca, shared a post on LinkedIn:
“The Gene Expression Testing Gap in Breast Cancer. Why Are Half of Eligible Patients Getting Chemotherapy Without It?”
Gene expression profiling (GEP) tests like MammaPrint and Oncotype DX exist for one core purpose: to spare early-stage breast cancer patients from chemotherapy they do not need.
When results come back low-risk, the data are compelling. In this large Dutch population-based study of over 138,000 patients, 93% of women with a low-risk MammaPrint result avoided chemotherapy. For low-risk Oncotype DX, that figure was 97%. These tests work – and when acted upon, they meaningfully reduce overtreatment.
The problem is not the tests. It is whether patients receive them.
Among 17,525 patients with a clinical indication for GEP, reimbursement status made a difference – but not enough of one. GEP use rose from 9% during periods of no reimbursement to 37% when reimbursement was publicly known. Yet even with full coverage available, only about one in three eligible patients actually received a test.
For the more than 13,000 indicated patients who went untested, over half received chemotherapy anyway – without the genomic information that might have pointed in a different direction.
Regional variation added another layer: GEP uptake differed meaningfully across the Netherlands, suggesting that access and institutional practice patterns – not just policy – are shaping who gets tested.
This study raises a pointed question. If reimbursement removes the financial barrier, what explains the remaining gap? Clinician awareness, referral patterns, patient-level factors, and system inertia all likely play a role – but the data to answer that question are not yet available.
Precision oncology tools are only as powerful as their reach. Coverage is a necessary condition for equitable access. It is clearly not a sufficient one.”
Title: Impact of Reimbursement on the Utilisation of Gene Expression Profiles and Chemotherapy Decision-Making in Dutch Breast Cancer Patients: A Population-Based Study
Authors: Joyce Meijer, Nienke Hermanns, Rhodé Bijlsma, Hedwig Blommestein, Desiree van den Bongard, Thijs van Dalen, Paul van Diest, Caroline Drukker, Cristina Guerrero Paez, Aafke Honkoop, Agnes Jager, Linetta Koppert, Sabine Linn, Marissa van Maaren, Ester Siemerink, Laura van ’t, José Volders, Marie Jeanne Vrancken Peeters, Sabine Siesling
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Other Articles Featuring George Kumar on OncoDaily.