Medicare cancer genomic testing rose, but many patients still miss it
Georgetown researchers found genomic testing among Medicare cancer patients rose to 16.7% in 2023, with NGS use still limited.
By Tom Brennan · Health & Medicine Correspondent
3 min read
Medicare cancer genomic testing became more common after federal coverage expanded, but most older beneficiaries with several common cancers still did not receive it, according to Georgetown University researchers. The finding matters because genomic tests can help doctors choose targeted therapies matched to a patient’s tumor.
The analysis, published in JAMA Network Open under the title “Genomic Testing Update Among Medicare Beneficiaries with Cancer,” examined Medicare claims from 2016 through 2023. Georgetown University Medical Center said the study focused on nearly 400,000 people ages 66 and older in traditional Medicare who had lung, breast, colorectal, prostate or endometrial cancer.
According to the researchers, overall use of genomic testing among these Medicare beneficiaries increased from 6% in 2016 to 16.7% in 2023. Use of next-generation sequencing, or NGS, remained comparatively low across the five cancer types despite national Medicare coverage, the study found.
What is next-generation sequencing in cancer care?
Next-generation sequencing is a form of genomic testing that can examine many cancer-related genes in one test. Georgetown researchers said that can make it easier for clinicians to identify tumor mutations and consider targeted treatment options.
Earlier genomic tests often reviewed one gene, or a small number of genes, at a time. The study distinguished between NGS tests and non-NGS genomic tests when tracking how testing changed after Medicare policy shifts.
How did Medicare coverage change?
Medicare broadened coverage for NGS testing in 2018 for somatic mutations, which are non-inherited genetic changes found in tumors, according to the study. Medicare added coverage in 2020 for germline mutations, which are inherited genetic changes.
Georgetown researchers described those coverage decisions as major steps toward wider access. Before those changes, coverage for genomic testing was more limited and less consistent, according to the university.
The researchers found the strongest increase in testing among people with lung cancer, where NGS is the dominant genomic testing method. Breast cancer patients, by contrast, continued to use non-NGS genomic tests more often, which the study linked to differences in available tests and clinical practice.
Who was less likely to receive testing?
The Georgetown team reported differences in testing rates by age, race, ethnicity and region. The researchers said the pattern suggests that insurance coverage does not by itself determine whether a patient receives genomic testing.
The study pointed to possible reasons including provider awareness, local resources and patient education. Lead author So-Yeon Kang of Georgetown University’s School of Health said the low use of NGS across all five cancers was a notable finding despite Medicare coverage for the tests.
Kang also noted a limitation: the claims analysis covered only older adults enrolled in traditional Medicare, so it cannot be directly compared with the full U.S. population. The study did not report outcomes for patients who did or did not receive testing.
The authors called for more research on whether broader genomic testing leads to greater use of precision therapies, better patient outcomes and acceptable costs. Georgetown said the researchers also plan to study why NGS remains underused and why use varies by cancer type and region.
This story draws on original reporting from Medical Xpress.