Breast cancer: genetic tests useful for one in four women, increase fund by 5 million

In Italy, almost one in four women with breast cancer could benefit from genomic tests. They enable the personalisation of post-operative treatment and limit the administration of inappropriate drugs. It is necessary to make these tests even more widely accessible by expanding the 20 million fund set up in 2020. This is what Giampaolo Bianchini (head of Breast Oncology in the Department of Medical Oncology at the Irccs Ospedale San Raffaele and professor at the Vita-Salute San Raffaele University) argues. "According to some estimates, a further 5 million euros should be added to the resources currently provided," Bianchini emphasises. "In fact, 13 thousand women a year would be able to take the test to choose the most appropriate adjuvant therapy, if these tests were used everywhere in the country. Five years ago only 10 thousand patients were calculated. Today, new estimates have identified a larger number of potentially eligible patients with the current reimbursement criteria. This is also due to increased use in smaller cancer centres. These tests are valid in hormone receptor positive (HR+) and HER2 negative early-stage breast cancer. Overall, up to 6,000 patients each year in Italy alone could avoid chemotherapy, which remains a pharmacological treatment with important side effects for patients and significant costs for the national health service'.

New scientific evidence on genomic testing comes from the international San Antonio Breast Cancer Symposium. A new study on the Oncotype Dx genomic test conducted in five Irish cancer centres was presented in the Texan city in recent days. The test, which was used to identify patients with positive lymph nodes who could avoid chemotherapy, led to savings of over 60 million euros associated with the use of chemotherapy over an 11-year period. Also announced at the same meeting was the start of a randomised phase III clinical trial to be conducted by the Japan Clinical Oncology Group (JCOG). The aim is to optimise adjuvant treatment for premenopausal women with HR+ and HER2-negative breast cancer.

'These are just two examples of the great opportunities offered by genomic tests worldwide,' Bianchini continues. 'In our country they were introduced into clinical practice relatively late, even though they have been included in the main international guidelines for many years. The fund was created in 2020 and the planned resources did not actually become available in all 21 Italian healthcare systems until many months later. Now, five years later, the fund must be increased as soon as possible to allow all patients to have the same opportunities. Precision medicine is an established reality in breast cancer where diagnosis and treatment are more personalised. This is one of the main reasons for the great successes we have achieved in the management of this neoplasm. The chances of cure and recovery increase the earlier the diagnosis is made and the earlier the tumour is at an early stage. The latest innovative drugs act selectively on single mutations or are only effective on certain disease subgroups. All the tools at our disposal that can make diagnoses more precise are therefore crucial and their use should be encouraged and promoted as much as possible'.