HER2 Testing Inaccessible for Many Women With Breast Cancer

By Reuters Staff

May 03, 2019

NEW YORK (Reuters Health) - A survey of HER2 testing of breast cancer in 45 countries highlights major issues around access and affordability in low- and middle-income countries (LMIC), with some problems extending even to upper-middle-income countries (UMIC).

"Even when HER2 testing was available, it was too expensive and inaccessible for many women, suggesting that governments need better information to set planning priorities for investing in infrastructure, testing and treatment," Dr. Sara Altuna of Unidad Oncologica Venezuela CA and Oncomedica CA, in Caracas, said in a news release.

She presented the survey results April 30 at the European Society for Medical Oncology (ESMO) Breast Cancer Congress in Berlin, Germany.

HER2, which is overexpressed in 15% to 20% of breast cancers, is both a prognostic biomarker and a predictive biomarker of response to anti-HER2-targeted therapies such as trastuzumab.

A total of 210 oncology providers in 45 countries responded to the survey asking about HER2 testing.

Forty-two percent of oncologists from UMIC and 34% from LMIC reported that HER2 testing was available only in a private setting or abroad, compared to 5% of those from high-income countries (HIC).

In addition, 30% of oncologists from LMIC reported significant affordability issues related to HER2 testing, including out of pocket expenses, as did 12% of UMIC. In HIC, there was full reimbursement for HER2 testing.

"You can have the microscopes, the antibodies and probes and the certified laboratories, but if patients cannot afford the tests or do not have insurance, they won't be done," Dr. Altuna said in the release.

"Without accurate, high quality HER2 testing, women with HER2-positive tumors may miss out on potentially lifesaving treatment," Dr. Fatima Cardoso, director of the breast unit at Champalimaud Clinical Center in Lisbon, said in the release. "There is also a risk that women with HER2-negative tumors may be exposed to the toxicity and unnecessary expense of HER2 treatment they don't need. We don't want to spend resources on treating tumors that won't respond to HER2 targeted therapies."

"Testing and treatment must go hand in hand," added Dr. Cardoso. "If you have access to anti-HER2 treatment, it makes sense to spend money on testing. But if you already know there is no access to treatment, it is debatable whether to use resources for HER2 testing. Let's first focus on ensuring that treatment is available as recommended by the WHO, by ESMO's and other international guidelines, for both primary and metastatic HER2-positive breast cancer."

Dr. Cardoso said the results of this survey "probably underestimate the access and affordability problems facing many patients, and not just in medium and low income countries. But they remind us of the need for clinicians, regulators and governments to work together in addressing these inequalities."

Dr. Altuna and colleagues are now investigating global prioritization and access to anti-HER2 targeted therapies. "We have shown it is possible to create a network of clinicians from very different countries to share practice and experiences and paint a picture of what is really happening in breast cancer care around the globe, so we can identify where improvements are most needed," she said in the release.

Dr. Altuna did not respond to a request for comment by press time. The study had no funding and the authors have declared no conflicts of interest.

SOURCE: http://bit.ly/2VL6l7D

ESMO Breast Cancer Congress 2019.