Recent news is full of positive reports about the 33 percent decline in cancer deaths1 since 1991 due to improvements in cancer treatment, decreases in smoking, the success of the HPV vaccine, and increases in early detection. The improvement in treatment is largely driven by advances in biomarker testing and targeted treatments for a growing number of cancers. This is great news for patients with those cancers, and means that their odds of survival, whether living with cancer as a chronic condition, or complete remission, is increasing dramatically. However, the role and benefits of cancer biomarker testing is often misunderstood.
The Role of Biomarkers in Cancer Treatment
Traditionally, cancers have been defined by where in the body they occur, but many newer treatments effectively target cancers based on specific “biomarkers”2 (genetic mutations in cancer cells), rather than the tumor’s location.
Biomarkers are molecules that can tell doctors about what is happening inside your body. They may be able to show how that condition is responding to treatment. Some biomarkers are simple such as blood pressure, heart rate or the results of blood and urine tests. Other biomarkers measure information at the molecular or cellular level. These more complicated measurements require lab testing. Biomarker tests3, which are also called molecular profiling, tumor testing, and genome sequencing, study genes, proteins, and hormones in the body. They also study genetic material that is shed into the bloodstream from cancer cells. Researchers use biomarker information to create new treatments. Doctors use it to help make informed decisions about treatment.
Targeting biomarkers has led to significantly more effective cancer treatment with fewer side effects for patients. Precision cancer treatments4 include targeted therapies (aimed at specific traits of cancer cells) and biomarker-guided immunotherapy treatments (that help a patient’s immune system fight their cancer).
Since 2001, the number of identifiable cancer biomarkers with associated therapies has grown from one to 55, with many more on the way. The list of cancers with clinically valid biomarkers includes many common cancers like lung cancer, breast cancer, melanoma, and colorectal cancer, as well as rare cancers like cholangiocarcinoma (bile duct cancer) and rectal cancer. Fueled by continual advances in research, this list is rapidly growing and contributing to the decline in cancer deaths. For example, lung cancer is the leading cause of cancer death worldwide and has been extremely difficult to treat. With the help of biomarker testing, targeted treatment, and immunotherapy, survival rates for some types of lung cancer have soared5, providing much encouragement to patients, clinicians, and researchers.
Biomarker testing can help clinicians select the best treatment for an individual patient, often avoiding one-size-fits-all chemotherapy and radiation that might not be effective for their cancer or may help identify opportunities to join a clinical trial.
What Patients Need to Know
Biomarker testing is done after a patient is diagnosed with cancer. It is not available for every cancer type, but every patient diagnosed with a cancer that has identifiable cancer biomarkers with associated therapy should have biomarker testing. Patients and their family members should ask their clinicians if biomarker testing is available for their type of cancer, and if it is they should request that it be done. If your clinician doesn’t offer biomarker testing but you have a cancer with an identifiable cancer biomarker, seek a second opinion.
Not every lab can perform biomarker testing, which may mean that samples must be sent to a specific lab that can perform the test. It’s important to check with your insurance company ahead of time to see if they cover biomarker testing and if they require prior authorization before it’s done. While biomarker testing can help patients avoid costly ineffective treatments and even surgeries, insurance industry policies don’t always reflect the evidence-based clinical treatment guidelines issued by professional associations such as the National Comprehensive Cancer Network6 (NCCN), the American Association of Clinical Oncology7 (ASCO), and the College of American Pathologists8 (CAP), all of which offer specific biomarker testing and treatment guidelines.
If your clinician recommends biomarker testing based on clinical treatment guidelines but your insurance company denies it, work with your clinician to appeal the decision using the evidence-based clinical treatment guidelines as justification. Unfortunately, many insurance companies use denials as a way of saving money, correctly assuming that most patients won’t appeal a denial of coverage. If the appeal doesn’t work ask whether the company that developed the test or its associated treatment will cover the cost.
One Last Thing
Many people confuse biomarker or genome testing with genetic testing9, which looks for specific inherited changes in a person’s genes that can provide information about their risk for certain cancers. Genetic testing is generally recommended for people with family histories of certain cancers to assess their risk. Biomarker/genomic testing is only done following diagnoses of certain cancers that can be treated with precision medicine. If your insurance company doesn’t cover genetic testing don’t assume that means they won’t cover biomarker testing – they are entirely different things.
Cancer Care’s Biomarker Tool kit
About the Author
Dr. Carolyn Messner, DSW, BCD, FAPOS, FAOSW, LCSW-R is Senior Director of Education and Training, CancerCare. She is coeditor of the inaugural Oncology and Palliative Social Work: Psychosocial Care for People Coping with Cancer (Oxford University Press, 2024) and the Handbook of Oncology Social Work(Oxford University Press, 2015). Dr. Messner is Associate Editor of Journal of Psychosocial Oncology and on the editorial boards of Journal of Cancer Education and The Journal of Interprofessional Practice. She is a Fellow and former President of the Association of Oncology Social Work (AOSW). Her expertise includes methods to design patient education interventions, the psychosocial impact of cancer, and cancer in the workplace.
1 NIH: US cancer death rate falls 33% since 1991, partly due to advances in treatment, early detection and less smoking, report says. https://www.ncbi.nlm.nih.gov/search/research-news/17988/
2 CancerCare: Biomarker basics. https://www.cancercare.org/biomarkers#!biomarker-basics
3 National Cancer Institute: Biomarker Testing for Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment#:~:text=Biomarker%20testing%20is%20a%20way,how%20certain%20cancer%20treatments%20work
4 Cancer Action Network: Biomarker Testing: Advancing Precision Medicine in Cancer Care. https://www.fightcancer.org/sites/default/files/docs/precision_medicine_and_biomarker_testing_jan_2022.pdf
5 Asian Pacific Journal of Cancer Prevention: Lung Cancer Survival with Current Therapies and New Targeted Treatments: A Comprehensive Update from the Srinagarind Hospital-Based Cancer Registry from (2013 to 2017). http://journal.waocp.org/article_89714.html.
6 National Comprehensive Cancer Network. https://www.nccn.org/guidelines/category_1
7 American Association of Clinical Oncology. https://old-prod.asco.org/practice-patients/guidelines
8 College of American Pathologists. https://www.cap.org/protocols-and-guidelines/current-cap-guidelines
9 Genetic, Genomic, or Biomarker Testing in Cancer—What Is the Difference? https://conquer-magazine.com/issues/special-issues/may-2020-biomarkers-genetic-testing/1246-genetic-genomic-or-biomarker-testing-in-cancer-what-is-the-difference
10 CancerCare What are biomarkers? https://www.cancercare.org/biomarkers#!biomarker-basics
