Biomarker testing has become one of the most powerful tools in modern oncology, linking a tumor’s genetic or molecular profile to the most effective treatment. Yet, despite its proven ability to improve survival and reduce treatment toxicity, access remains uneven across patient populations. When eligible patients are not tested, opportunities for targeted or immunotherapy treatments are often lost, leading to delayed or less effective care. Therefore, equitable access has become a moral and medical imperative for the oncology community.

“The conversation around biomarker testing equity needs to move from ‘if’ to ‘how.’ The technology exists today, and so does the evidence. The question is whether we have the collective will to make equitable access a global reality,” said Patrick Frey, PhD, Head of Precision Medicine at Mindpeak, an organization enabling personalized cancer treatment through AI tissue diagnostics. “I believe we do, and it starts with collaboration between science, policy, and practice. If we can do that, we can transform outcomes for entire patient populations.”

The Promise & Proven Benefits of Biomarker Testing

Comprehensive biomarker testing is now widely recognized as essential in oncology and is becoming standard practice in leading cancer centers, particularly in diseases such as breast, lung, and colorectal cancer, said Frey.

Biomarker testing directly impacts patient outcomes by enabling personalized treatment strategies that are more effective and less toxic, added Luca Quagliata, PhD, BCMAS, COA, Vice President and Global Head of Medical Affairs at Thermo Fisher Scientific.

“In non-small cell lung cancer (NSCLC), identifying specific genetic mutations allows targeted therapies that can significantly improve survival compared to standard chemotherapy. In cancers like breast and colorectal, testing can identify patients likely to respond to specific treatments, improving response rates and quality of life. Overall, biomarker testing helps clinicians tailor therapies to individual patients, optimizing outcomes while minimizing unnecessary side effects.”

But while comprehensive biomarker testing uptake has expanded markedly over the last 5 years, real-world implementation still lags behind guideline recommendations across most advanced solid tumors, with fewer than 50% of patients with advanced cancers receiving any biomarker testing prior to first-line therapy, Quagliata said.

Misconceptions & Disparities in Biomarker Testing

Conflating the disparities in adoption, misconceptions deepen among patients around what biomarker testing entails and who it benefits.

“Patients need to understand what biomarkers are, why they matter, and how they can influence treatment,” Frey said. “Clear, accessible communication is essential. We need to move beyond technical jargon and explain biomarker testing in terms of what matters most to patients—that it can open doors to more personalized, effective treatments.”

Quagliata noted that important progress is underway, with advocacy groups investing in accessible education resources, policy changes to reduce barriers, and collaboration with healthcare providers to ensure that testing is integrated into standard care practices.

“By raising awareness and providing resources, patient advocacy groups help empower patients to engage in shared decision-making with their healthcare providers, leading to better-informed treatment choices and improved outcomes.”

Even when patients understand and qualify for biomarker testing, barriers to testing endure. Large gaps exist across tumor types, geographies, and patient populations. Lung cancer remains the clear front-runner, Quagliata said, where biomarker testing is well established and supported by a robust therapeutic landscape.

“By contrast, ovarian (17%), breast (27%), and pancreatic cancers (42%) show markedly lower testing rates compared with NSCLC (over 50%), reflecting the later integration of targeted therapies into standard care,” he said.

Beyond tumor type, deep inequities across geographies persist, driven by national healthcare infrastructure, reimbursement policies, and payer mix.

“Patients treated in academic centers are far more likely to receive comprehensive testing than those in community or regional hospitals, while African American patients, individuals in higher-poverty or rural areas, and Medicare Advantage beneficiaries are significantly less likely to undergo comprehensive testing,” Quagliata added.

Systemic & Logistical Barriers

Additional barriers around logistics such as insurance coverage, turnaround time, or tissue availability further impact biomarker testing equity.

“Logistically, pathology workflows are still heavily manual, so even when oncologists order tests, results can be delayed or inconsistent,” Frey said. “If tissue is scarce or turnaround times are long, testing might be deprioritized, especially for advanced-stage patients who need decisions quickly.”

Quagliata noted that up to 50% of missed tests in some regions result from insufficient tissue, highlighting the need for better biopsy protocols and coordinated multidisciplinary care.

Financial disparities, particularly in rural areas, further exacerbate access gaps.

“Financial barriers often stem from inconsistent insurance coverage, high out-of-pocket costs, and complex prior authorization requirements,” Quagliata said. “Patients with Medicare Advantage or in lower socioeconomic regions are less likely to be tested, and even when coverage exists, copays and reimbursement limits can discourage testing.”

Frey added that when payers hesitate to reimburse certain tests, clinicians face a dilemma between clinical necessity and financial feasibility.

“This creates inequity at the most basic level and some patients are simply priced out of precision care.”

On an institutional level, reliance on outdated testing infrastructure, limited panels, or inconsistent scoring methods means that oncologists are often performing tests too late.

“In short, the science has moved faster than the systems supporting it,” Frey said. “Bridging the gap from ‘recommended’ to truly ‘routine’ will depend on improving access, accelerating insights, and providing tools that help clinicians act with confidence on complex data—an area where precision medicine and AI can have real impact.”

Driving Change: How Providers & Institutions Can Lead

Making that jump to true equity won’t only improve outcomes for patients. Implementing biomarker testing can have both short- and long-term economic effects, Quagliata said.

“Short-term costs include testing and targeted therapies, but long-term benefits include improved outcomes, fewer hospitalizations, and reduced adverse events. By identifying the most effective therapies early, healthcare systems can avoid the costs of ineffective treatments.”

Healthcare providers and institutions can boost testing rates by implementing standardized protocols, integrating reflex testing into workflows, and ensuring all eligible patients are offered testing as part of routine care, he recommended. Providing clinicians with education and training on the importance of testing and current guidelines also helps improve adherence, while collaborating with laboratories to streamline the process and reduce turnaround times can further increase testing rates.

“Creating a culture that prioritizes precision medicine ensures more patients benefit from biomarker-driven care,” he said.

On an individual level, Frey urges oncologists to make biomarker testing a routine part of the diagnostic conversation. A push for reflex testing protocols, collaboration with pathology departments to streamline workflows, and ensuring every patient’s tumor is evaluated against the latest evidence are key, he said.

“Advocacy also means engaging with administrators and policymakers to show how equitable testing improves both outcomes and efficiency. When clinicians lead that conversation, it often accelerates change within their networks.”

The Path Toward Equity

In the end, equitable biomarker testing is about more than access to technology. It’s about justice in healthcare. Ensuring that every patient benefits from the best available science requires aligning innovation with intention and turning equity from an aspiration into standard practice.

“Equity means every patient, regardless of where they live or which hospital they attend, has timely access to comprehensive, high-quality testing, and that those results are interpreted consistently and used to guide care,” Frey said. “Getting there requires aligned incentives across stakeholders—clinicians, payers, regulators, and technology providers. But most importantly, it requires the mindset that precision medicine is a right, not a privilege.”

Quagliata expects future developments to include more rapid, cost-effective, and comprehensive testing technologies.

“With the rise of fully-automated, easy-to-deploy next-generation sequencing solutions and increasing policy momentum, I believe the next 5 years can bring us closer to a ‘no patient left behind’ reality. The path is clear and the infrastructure exists, but it will take the oncology community working together to move it forward.”