Breast cancer. Aiom Congress: “6 out of 10 patients are not prescribed genomic testing. These exams are included in the Lea “

In Italy in total there are over 10 thousand women who can use them. President Saverio Cinieri: “We still encounter bureaucratic delays, organizational problems and an underestimation of the potential of molecular tests that help select treatments and limit the use of unnecessary chemotherapy”. The results of a survey conducted among 212 doctors presented at the National Congress in Rome.

03 OCT

Genomic tests for breast cancer, to avoid unnecessary chemotherapy for eligible women, are struggling to be used in Italy. This is happening despite having been made reimbursable by a decree of the Ministry of Health in July 2021. After 14 months of the more than 10 thousand eligible women only 4,000 have performed the molecular examination. 60% of patients therefore do not resort to simple, minimally invasive and free tests that can severely limit the use of useless oncological treatments.

The alarm of the specialists comes on the occasion of the last day of the XXIV National Congress of the Italian Association of Medical Oncology (Aiom). The event takes place these days in Rome and sees the participation of over 2,000 specialists from all over the Peninsula.

“Genomic tests represent an important heritage for both patients and doctors – he says Xavier Cinieri, National President Aiom -. At the end of 2020, the law was approved that created an ad hoc fund for the purchase of exams, which was followed by an implementing decree. As Aiom we helped write that provision and it was the first time that the National Health Institutions called our Scientific Society and started this kind of collaboration. Many months have passed, in which the 21 regional and provincial health systems present in Italy have made the national law effective with other implementing decrees and the start of tenders. After all this time, however, we still encounter bureaucratic delays, organizational problems and, more generally, an underestimation of the potential of the tests that make them in fact underutilized “.

AIOM carried out an internal investigation among 212 young doctors on genomic examinations for breast cancer. For six out of ten oncologists, the tests should be included in the Essential Levels of Assistance (LEA). “The latter may be a possible solution to a problem that we have been dragging on for too long – he continues Antonio RussoNational Treasurer Aiom e Michelino De Laurentiis, Director of the Department of Breast and Thoraco-Pulmonary Oncology of the National Cancer Institute Irccs Pascale Foundation of Naples -. They are exams that present a high level of scientific validation and that allow to identify the potential risks of under or over treatment. They then establish a possible need for therapeutic intensification. Genomics, applied to breast cancer, allows us to better define tumor tissue. We can predict the likelihood of cancer recurrence following surgery and the response to therapies. Chemotherapy is not always necessary after these first treatments and thanks to the tests we establish it with precision “.

“The time has come for genomic tests to be more promoted in Italy too – he adds Ugo De Giorgi, National Councilor Aiom -. Our country has already come late, compared to others, in the use of exams that have been an ordinary precision oncology tool for years in many Western countries. Obviously they should be used only in specific cases, that is, in luminal tumors, those that express estrogen receptors but not the HER2 protein. These women can only be treated with hormone therapy. We must also make more culture among oncologists as 26% of the interviewees argue. In-depth webinars and awareness campaigns are needed to tackle the underutilization of exams. Like Aiom, we have already moved in this direction and will launch new initiatives ”.

In Italy breast cancer is the most diagnosed neoplasm in women where it represents 30% of all cases of malignancy. “Precision oncology and multidisciplinarity are two of the most effective weapons to combat such a widespread disease – he says Marcello Tucci, National Councilor Aiom -. There are, in fact, different types of mammary neoplasia, each of which has different anatomical-pathological and biological characteristics. The prescription of a genomic test, for a better selection of therapies, must be established by a multidisciplinary team. Again according to our survey this already happens in 62% of cases while in 11% it is the exclusive task of the oncologist. An important operational role is played by the pathologist who, through the slide and the microscope, can establish which are the groups of genes expressed in a specific tumor tissue “.

“Chemotherapy is a cure that must not be demonized as it has allowed us to obtain excellent results in terms of survival – he concludes Cinieri -. However, it has some side effects that are not negligible and still strongly feared by women, such as hair loss. Drugs also have considerable economic costs that weigh on the national health system. Now even in Italy we can use tests that determine concrete and real benefits for the individual patient as well as the entire community. It must be a priority for us oncologists to favor their use as much as possible “.

03 October 2022
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