Breast cancer, in Lombardy 8 out of 10 patients access genomic tests
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Eight out of ten breast cancer patients living in Lombardy have free access to genomic tests, should it be necessary to perform them. We are talking about tests that, in some specific cases, can help doctors understand if chemotherapy is necessary or avoidable. It is estimated that in the course of 2022 in Lombardy approximately 1,500 of the 1,800 potentially repayable will be carried out, i.e. over 80%. And this percentage makes Lombardy an example to be followed by other regions where, on the other hand, the system still fails to fully exploit the funds allocated to guarantee access to genomic tests: on average, in Italy, the percentage is 40%. The numbers emerge from the conference “Oncotype DX Test: a milestone in the evolution of the health system”, which was held yesterday in Milan in the Palazzo della Regione, which was attended by representatives of clinicians and patient associations.
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The primacy of Lombardy
The primacy of Lombardy is due to several factors starting from the fact that the Region has made the tests free since 2019. “Lombardy was the first Region of our country that reimbursed genomic tests well before the creation of the national institute fund at the end of 2020 – says Daniele Generali, Director of the Complex Multidisciplinary Structure of Breast Pathology and Translational Research of the ASST of Cremona: “It is a virtuous example of regional welfare that has a positive impact on the lives of thousands of women and families”.
Oncological aesthetics favors adherence to care
Genomic tests
Genomic testing is indicated for patients with early stage breast cancer that is responsive to female hormones (which accounts for approximately 60% of breast cancer cases) and is considered to be at “intermediate risk” of returning or metastasizing. For them, chemotherapy is not always necessary: ”In these cases, the choice of an appropriate adjuvant therapy is a particularly difficult challenge”, explains Giancarlo Pruneri, Director of the Department of Pathology – IRCCS Foundation National Cancer Institute of Milan: ” We pathologists can help the multidisciplinary team to choose the best possible treatment for each patient, and which has fewer side effects. Traditional clinical pathological parameters are not always adequate to identify those women who can really benefit from chemotherapy. genomics thus become an effective, reliable work tool that offers great benefits for everyone the lost day is equivalent to chemotherapy done unnecessarily “.
Up to 75% fewer chemotherapy
According to experts, optimizing and personalizing anti-cancer treatments must be two priorities: “With genomic tests we can reduce the use of adjuvant chemotherapy by up to 75%, thus limiting toxicity to patients and costs for therapies to the various regional health systems” , underlines Alberto Zambelli, associate professor of medical oncology at Humanitas University: “Despite these important data, the use of genomic tests is still low, especially in some regions. In total there are over 10 thousand patients throughout the Peninsula who could benefit from the tests, while currently just over 4,000 have been carried out “.
Government, challenges and opportunities for health
Our national health system – continues Zambelli – is very late in the use of genomic tests. In fact, in several Western countries, they have been introduced for over ten years. And bringing genomic testing into LEA (Essential Levels of Assistance) would be desirable. There is also an inertia of the system that must be overcome, concludes the doctor: “In order to get the results of the examination in a timely manner, it is possible to resort to solutions and procedures capable of accelerating waiting times. This is the case of the standardized request for genomic testing, which must be initiated on the basis of multidisciplinary judgment “.
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