Molecular Testing in Advanced Endometrial Cancer Has Increased, Access Gaps Remain
- Biomarker testing among patients with primary advanced/recurrent endometrial cancer (pA/rEC) increased significantly between 2013 and 2021.
- Mismatch repair/microsatellite instability (MMR/MSI) testing saw the greatest increase, from 17% in 2013 to 81% in 2021.
- Patients treated at academic centers, with commercial/other insurance, or with specific clinical characteristics were more likely to undergo biomarker testing.
- Disparities in testing access underscore the need for more equitable and universal implementation of molecular diagnostics.
A recent study observed that between 2013 and 2021, the use of biomarker testing in patients with pA/rEC rose markedly, from 53% to 89%. MMR/MSI testing in particular increased more than fourfold, while estrogen receptor/progesterone receptor (ER/PR) and human epidermal growth factor receptor 2 (HER2) testing also demonstrated notable gains.
Molecular testing is now a key component in guiding treatment decisions for endometrial cancer, particularly in the advanced or recurrent setting. This study was conducted to assess real-world patterns in the use of biomarker testing among women with pA/rEC and to identify demographic and clinical characteristics associated with likelihood of testing. Understanding these patterns can help address gaps in testing access and align clinical practice with guideline recommendations.
This retrospective cohort analysis used a nationwide deidentified electronic health record (EHR) database to evaluate biomarker testing in women aged 18 years or older with pA/rEC. The full cohort spanned records from January 1, 2013, to August 31, 2023, and included data on MMR/MSI, HER2, and ER/PR testing. An additional subsample, the advEndo Spotlight data set (April 1, 2013–November 30, 2022), provided further molecular testing data. Testing rates were reported by year and molecular marker. Multivariate logistic regression was used to examine factors associated with testing.
Among 2982 patients in the full cohort, 53% were aged 65 years or older, 56% were non-Hispanic White, and 73% received care in a community setting. In the advEndo Spotlight subsample (n = 509), patient characteristics were comparable. From 2013 to 2021, the rate of any biomarker testing increased from 53% to 89%. MMR/MSI testing rose from 17% to 81%, ER/PR from 45% to 62%, and HER2 from 15% to 43%. Factors associated with increased likelihood of testing included care in an academic setting, having commercial/other insurance (vs Medicare/Medicaid), a diagnosis of primary advanced (vs recurrent) EC, endometrioid histology, and absence of previous surgery for primary treatment.
The study had several limitations. Emerging biomarkers such as BRCA1/2 and NTRK fusions were not evaluated. Due to the deidentified nature of EHRs, testing outcomes were not validated, and some relevant clinical data were missing or unavailable. Additionally, the databases predominantly reflected commercially insured populations, which may limit generalizability.
“Molecular testing rates in pA/rEC have increased over time, likely due in part to incorporation of biomarker testing into treatment guidelines,” the study authors concluded. “This highlights an unmet need to ensure universal access to testing in patients with pA/rEC.”
Reference
Chen Y, Lubinga SJ, Williams T, Carlson JJ, Ramsey S. Real-world molecular testing rates and patterns in patients with primary advanced or recurrent endometrial cancer in the United States. JCO Precis Oncol. 2025;9:e2400815. doi:10.1200/PO-24-00815