Genomic testing remains underused among cancer patients despite the growing role of genetic and molecular information in modern cancer care, with new research highlighting continued gaps in access to testing even when Medicare coverage is available. Genomic testing involves examining a person's tumour or genetic material to identify specific changes that may help doctors better understand a cancer and determine which treatments could be appropriate. As cancer treatment becomes increasingly personalised, these tests are playing a growing role in helping physicians make decisions based on the biological characteristics of an individual patient's disease. However, having coverage for a medical test does not necessarily mean that every patient who could benefit from it receives one. Recent research has highlighted the continued gap between the availability of genomic testing and its actual use among cancer patients. The findings suggest that a significant number of eligible patients are not receiving recommended testing, raising concerns about whether all patients have equal access to advances in precision medicine. ### Why genomic testing matters Cancer is not a single disease. Even when two patients are diagnosed with the same type of cancer, the genetic and molecular characteristics of their tumours can be different. Genomic testing can help identify mutations and other changes that may influence how a tumour behaves or responds to particular treatments. In some cases, identifying a specific genetic alteration can help doctors determine whether a patient may benefit from a targeted therapy. Testing can therefore provide additional information beyond what is available from traditional diagnostic methods. For patients with certain cancers, genomic information can help physicians select treatments that are more closely matched to the characteristics of the tumour. It may also help identify patients who could benefit from specific targeted therapies or clinical trials. ### Medicare coverage does not guarantee access One of the important issues highlighted by the research is the difference between insurance coverage and actual access to healthcare. Medicare coverage can reduce the financial barrier associated with genomic testing, but other obstacles may still prevent patients from receiving the tests. These obstacles can include differences in healthcare systems, availability of specialists, access to appropriate laboratories, physician awareness, geographic location and the ability of patients to navigate the healthcare system. In some cases, clinicians may also have different approaches to ordering genomic tests depending on the type and stage of cancer being treated. As a result, patients who theoretically have access to covered testing may still experience delays or never receive the test at all. ### Differences among patients The researchers also point to the possibility of disparities in genomic testing. Access to advanced cancer care can vary considerably depending on where a patient lives, the healthcare facility providing treatment and other socioeconomic factors. Patients treated at large academic medical centres may have easier access to specialised oncology services and molecular testing than patients receiving care in smaller or rural facilities. These differences can become particularly important as precision medicine becomes more common. If genomic testing helps determine which treatments are available to a patient, differences in testing rates could ultimately contribute to differences in treatment options and cancer outcomes. ### The growing importance of precision medicine The findings come at a time when precision medicine is becoming increasingly important in oncology. Traditional cancer treatment often relies on the location and type of cancer, along with factors such as its stage and the patient's overall health. Genomic information can provide another layer of detail by showing the specific biological changes driving a tumour. This approach has contributed to the development of targeted cancer therapies designed to act on particular molecular abnormalities. As more targeted treatments become available, the importance of identifying patients who may benefit from them is also increasing. This creates a challenge for healthcare providers: new technologies and treatments can only improve outcomes if patients who are eligible can actually access the testing required to identify appropriate treatment options. ### Barriers beyond cost Although the cost of testing is an important consideration in healthcare, the research suggests that financial coverage is only one part of the problem. Healthcare providers may need additional resources, training and infrastructure to integrate genomic testing into routine cancer care. Patients may also need clearer information about why a test is being recommended and how the results could influence their treatment. For some patients, the process can involve obtaining tumour samples, arranging laboratory analysis and waiting for results before a treatment decision can be made. These logistical challenges can make genomic testing more difficult to implement consistently across different healthcare settings. ### What the findings could mean for cancer care The continued underuse of genomic testing raises questions about how healthcare systems can ensure that advances in cancer medicine reach the patients who need them. Researchers and healthcare professionals may need to look beyond insurance coverage and examine the practical barriers that prevent eligible patients from being tested. Improving physician education, expanding access to specialised laboratories, strengthening referral systems and ensuring that patients understand the potential benefits of testing could all help increase appropriate use. Healthcare systems may also need better methods for identifying patients who meet testing recommendations so that eligible individuals are not missed. ### A challenge for personalised cancer treatment The promise of genomic medicine is based on the idea that cancer treatment can increasingly be tailored to the individual patient. But personalised medicine depends on accurate information. When patients who could benefit from genomic testing are not tested, doctors may have less information available when considering treatment options. This can make it harder to identify certain molecular targets or determine whether a patient may qualify for a particular targeted therapy or clinical trial. The issue is therefore not simply whether genomic testing exists, but whether patients can access it at the right time and whether the results are effectively incorporated into their care. ### Looking ahead As genomic technologies continue to develop and become more widely incorporated into cancer treatment, ensuring equitable access will become increasingly important. Medicare coverage represents an important step toward making testing more accessible, but coverage alone may not eliminate the other barriers patients and healthcare providers face. The latest findings highlight the need for continued efforts to understand why eligible cancer patients are not receiving genomic testing and what healthcare systems can do to close the gap. For patients, doctors and policymakers, the broader message is clear: advances in precision oncology can only have their intended impact when the patients who stand to benefit from them can access the necessary testing. As cancer care continues to move toward more personalised treatment, improving the availability and appropriate use of genomic testing could become an increasingly important part of ensuring that medical advances translate into better and more equitable care.