Cancer Testing Gap: Billions Spent, Millions Unserved

Access to essential genomic testing and matched cancer treatments exhibits profound inequalities both within and between nations. A significant disparity exists in cancer genetic testing research, with a mere 2% of biomarker-based trials taking place in low- and middle-income countries (LMICs) compared to nearly 81% in high-income nations.

An international team of authors has identified a "paradox of success" in precision oncology. While this field has rapidly advanced, its increasing cost and complexity have outpaced the delivery of population-level benefits. Global expenditure on cancer medicines has escalated dramatically.

Spending on cancer drugs increased by about 75% over the last five years, reaching an estimated USD 252 billion in 2024. Projections indicate this figure could rise to USD 441 billion by 2029. Researchers analyzed global data and surveyed national cancer programs.

Annually, an estimated seven to eight million people with cancer require standard molecular testing. However, coverage is far from universal, particularly in LMICs. For instance, an estimated 3.14 lakh women with ovarian cancer are eligible for BRCA testing yearly, yet about half do not receive it, largely due to low testing rates in LMICs.

To address these systemic issues, the commission has introduced a framework for prioritizing molecular tests and therapies. It also offers a tool for assessing system readiness and a competency framework for the healthcare workforce. Principles for responsible data sharing are also outlined.

The commission has put forth 10 core recommendations for integrating precision oncology equitably and effectively into cancer control and universal health coverage. A phased implementation roadmap is also provided to guide this integration process.