Addressing the rural and small urban cancer treatment gap:The right treatment starts with the right answer
As hospitals close, rural and small urban communities are less likely to have access to consistent cancer care. And they are even less likely to have access to more advanced and comprehensive measures that can save lives.
When doctors suspect cancer, they usually start with a scan to find the tumor and a biopsy–a small tissue sample–to confirm it. Together, these show where the cancer is and how far it has spread.
But they don’t show why the cancer is growing or which medicines are most likely to work against it.
That’s what biomarker testing is for. Two people can have the same type of cancer but their tumors can behave very differently and respond to different treatments. A biomarker test examines a sample of the tumor to find the specific features that are driving its growth. With that information, doctors can choose the treatment most likely to work for each patient.
Scans + biopsy
Where is it? What does it look like?
Biomarker testing
What is driving it? What treatment may fit?
Not all biomarker testing is the same.
“Biomarker testing” can involve looking for one specific genetic change or assessing many potential changes at once.
one target
Single-marker testing
A single-marker biomarker test looks for one known change that is already suspected. Many cancers, however, are not driven by just one culprit – and if the cancer is driven by something else, the test may miss it.
many targets searched simultaneously
Comprehensive biomarker testing
Comprehensive biomarker testing evaluates many changes at once in a single test, helping identify the change driving a patient’s cancer, including ones that may not have been expected.
So why isn’t every patient getting this testing?
Scans and biopsies are standard steps in cancer care. Biomarker testing isn’t. It isn’t always ordered, and insurance doesn’t always cover it, which can leave patients and hospitals with large costs. That leaves doctors with a tough choice: wait for the test results, or start a standard treatment right away and change course later. This is especially true in rural and small urban communities where care is less accessible. We know from The Community Oncology Alliance (COA) that almost 55% of Americans who are battling cancer are currently receiving their care and treatment in community settings rather than hospital-based care.
Patients deserve the right answer before treatment begins. Starting the wrong treatment doesn’t just cost lives. It also wastes precious health resources in communities that can’t afford to, resulting in lost time, unnecessary side effects, and a delay in getting the treatment that actually fits.
When testing comes too late
- Diagnosis
- Treatment begins
- Test result arrives
- Treatment changes
With timely comprehensive testing
- Diagnosis
- Test
- Result
- Treatment selected
The filled marker shows when the biomarker result arrives. In the first path, treatment is already under way before the answer comes back.
The science is already here. Access is the problem.
Biomarker testing should be a regular part of cancer care, alongside scans and biopsies, especially in rural and small urban communities where it’s harder to get access to regular cancer care. Doctors shouldn’t have to choose between what a patient needs and what the system will pay for. Every patient deserves timely access to this test so the right treatment decision can be made from the start.
“Starting the wrong treatment can mean wasted time, unnecessary side effects and delays in getting the treatment that fits.”
The right answer can change everything
Lung cancer
The Order Matters
The test was late. The $44,000 treatment wasn’t.
A patient with advanced lung cancer starts a standard treatment while their comprehensive biomarker test is still being analyzed. When the results come back, they show a DNA change that points to a different, targeted drug. Their treatment changes, but only after the first, more expensive drug has already been used.
Why this matters
Getting biomarker test results in time matters just as much as getting the test itself. If results come back after treatment starts, it may be too late to avoid the wrong drug and unnecessary costs.
Colorectal cancer
The Drug Had Nothing to Target
The test wasn’t covered. The drug it would have ruled out was.
A patient with colorectal cancer starts treatment while waiting for comprehensive biomarker test results. The results later reveal a mutation that changes the treatment path. If those results had come sooner, their care team could have considered that information from the start, potentially avoiding time and costs associated with the initial treatment.
Why this matters
Biomarker testing can show whether a treatment is likely to work before a patient starts it. For some drugs, that means avoiding treatment that won’t help, along with unnecessary side effects.
Breast cancer
The Cancer Changed. The Treatment Didn’t.
The scan said stay. The blood could have said switch.
A patient with advanced breast cancer stays on the same treatment because their scans still look stable. But their cancer has developed a DNA change that makes it resistant to that treatment. A biomarker test could have caught the change before it showed up on a scan and allowed their doctor to switch treatments sooner.
What the scan showed
A tumor that still looks stable.
What the biomarker test could show
A DNA change that makes the cancer resistant to that treatment.
Why this matters
Comprehensive biomarker tests and scans tell doctors different things. A scan shows what the tumor looks like now, while a biomarker test can show how the cancer is changing underneath. Together, they give doctors a more complete picture to guide treatment decisions.
Rare mutations
No One Looked for Rare
“Rare” was the reason not to test. It was the reason to test.
A patient with an advanced tumor has her blood tested for a few common genetic features, one at a time. Nothing useful turns up. After their first treatment fails, a comprehensive biomarker test checks for many features at once and finds a rare one that matches an FDA-approved treatment.
Why this matters
Comprehensive biomarker testing can check for many genetic changes at once, helping patients identify the right treatment sooner. Testing one gene at a time can lead to delays, repeat biopsies, and higher costs.
Four ways timely testing can change cancer care
$13.7K
can be saved with timely testing.
Lung Cancer
Patients who got their comprehensive biomarker test results in time were much less likely to receive a drug that didn’t match their tumor–potentially avoiding a treatment that costs about $44,000 and may not help.1
1 Test
can change the treatment choice
Colon Cancer
With colon cancer, even the FDA agrees that comprehensive biomarker testing can help rule out a specific mutation and point patients toward a clear treatment path.2
1 Week
vs. 5+ weeks to find the right target.
Rare Mutations
Comprehensive biomarker testing helped patients find the right treatment in 5-7 days, by looking for multiple cancer changes at once. That helped patients start the right treatment about 4 weeks sooner than testing for one change at a time.3
16 Months
vs. 9 months before the cancer worsens
Breast Cancer
A tumor can change at the DNA level before it shows up on a scan. Not every treatment works for every patient, so catching these changes early can help doctors know when it may be time to adjust treatment. One major trial found that using a comprehensive biomarker test to catch those changes early and adjust treatment nearly doubled the time before the cancer got worse, from about 9 to 16 months.4
Sources
- Real-world study of advanced non-small cell lung cancer, comparing timely versus delayed comprehensive genomic profiling. The study did not show a statistically significant difference in overall survival and should never be described as if it did.
- FDA companion-diagnostic labeling for cetuximab and panitumumab, which uses RAS mutation status to determine appropriate and inappropriate use in metastatic colorectal cancer.
- FDA tumor-agnostic approvals for NTRK gene fusions; modeled payer analysis in metastatic lung cancer comparing broad next-generation sequencing (2.1 weeks to appropriate treatment) with sequential single-gene testing (5.2 weeks). This is a modeled result dependent on the study’s assumptions, not an observed clinical outcome.
- SERENA-6, a randomized phase 3 trial of ctDNA-guided treatment switching in ESR1-mutant, hormone receptor-positive metastatic breast cancer. Median progression-free survival was 9.2 versus 16.0 months in the initial analysis, with an extended 2026 analysis reporting 16.8 versus 9.2 months. Findings are specific to this breast cancer setting and should not be generalized to other cancers.