Genomic tests reveal the identikit of the tumor and allow the identification of targeted and more effective treatments on a case-by-case basis
More and more effective and targeted treatments, case by case, for breast cancer and deaths are decreasing in percentage. It is almost an equation, the one that links the successes of science and "tailor-made" therapies for each woman to the decrease in deaths from breast cancer in Italy: estimates speak of a reduction in deaths that exceeds 6% from 2015 to today, also thanks to screening programs and early diagnosis.
But precisely the need to precisely calibrate the therapies, thanks to the knowledge of the "intimate" and invisible characteristics of cancer cells, can become a key discriminant. To meet the needs of women, genomic tests are therefore necessary, obviously when indicated, which reveal the identikit of the tumor and allow you to "take aim" with the most effective treatments for that case.
Find out if chemotherapy is needed and in whom
About 70% of breast cancer cases are of the luminal type, i.e. it expresses estrogen receptors but not the HER2 protein (ER + / HER2-). "After surgery, systemic treatment involves the use of hormone therapy in cases considered to be at low risk or the addition of adjuvant chemotherapy (ie after surgery) to hormone therapy, in the presence of a high risk" – underlines Saverio Cinieri, President-elect of the Italian Association of Medical Oncology (AIOM) and Director of Medical Oncology and Breast Unit of the 'Perrino' Hospital in Brindisi.
"In 'intermediate' risk luminal disease, however, there is significant therapeutic uncertainty, because in international and national guidelines there are no binding indications on when it is possible to omit chemotherapy or when it is necessary to administer it. These cases are placed in a sort of 'gray area', in which the choice of the correct therapy following surgery is challenging, also because the traditional clinical-pathological parameters have proved not to be selective in identifying the patients to whom chemotherapy can be spared ".
“Genomic tests evaluate groups of genes expressed in a specific tissue, studying their functions and the ways in which they interact with each other. That is, they provide the personalized molecular profile of a tumor. And they represent an extremely important tool for doctors, helping them to decide in which patients chemotherapy is really useful ”.
For these reasons, these exams are recommended by the guidelines of the Italian Association of Medical Oncology (AIOM) and by the most important international guidelines, such as those of the European Society of Medical Oncology (ESMO), of the American Society of Clinical Oncology (ASCO). , the National Comprehensive Cancer Network (NCCN) and the St. Gallen International Breast Cancer Conference.
How is it going in Italy
So why are genomic testing important? Simple. In some patients affected by breast cancer, they allow us to predict the risk of relapse and, therefore, to exclude chemotherapy in addition to hormone therapy after surgery, avoiding unnecessary toxicity.
"Chemotherapy increases the likelihood of contracting Covid-19 and increases its lethality, through a decrease in the immune system" – explains Francesco Cognetti, President of the Together Against Cancer Foundation and Director of Medical Oncology Regina Elena in Rome.
“Therefore, the tools that make it possible to avoid unnecessary aggressive treatments are also an important defense against the pandemic. Last December, the Budget Commission of the Chamber of Deputies approved an amendment to the Budget Bill, establishing a Fund of 20 million euros for the direct reimbursement of the expenses incurred by hospitals for the purchase of genomic tests in women with cancer. hormone-responsive breast at an early stage. The provision was included in the 2021 Budget Law. An implementing decree by the Ministry of Health is required to release the 20 million euros of the Fund. Immediately guaranteeing access to genomic tests throughout the territory is a battle of civilization ".
"Genomic tests, used in the main European countries, are free in Italy only in Lombardy, Tuscany and in the Autonomous Province of Bolzano, which have approved their reimbursement – says Rosanna D'Antona, President of Europa Donna Italia -. The standard included in the Budget Law is very important, because it goes in the direction of standardizing access to these molecular analyzes throughout the territory. It is now necessary for the regulatory process to take advantage of the resources allocated by the Government to be concluded as soon as possible and for the tests to be quickly made available to all women who can benefit from them ".