Barriers to g Testing in High-Risk HER2-Negative Early Breast Cancer.

Despite the OlympiA trial demonstrating that early-stage, high-risk, HER2- germline and mutation (g) positive breast cancer patients can benefit from PARPi in the adjuvant setting, the g testing rate in early-stage HR+/HER2- patients remains suboptimal compared to that in early-stage TNBC patients. To better understand the perceived barriers associated with g testing in HR+/HER2- disease, a quantitative survey was conducted across stakeholders ( = 430) including medical oncologists, surgeons, nurses, physician assistants, payers, and patients. This study revealed that while payers claim to cover g testing, poor clinician documentation and overutilization are key challenges. Therefore, payers place utilization management controls on g testing due to their impression that clinicians overtest. These controls have led to healthcare professionals experiencing payer pushback in the form of reimbursement limitations and denials. The perceived challenges to g testing stem from the lack of consensus dictating which patients are high risk and should be tested. While payers define high risk based on the CPS + EG score from the OlympiA trial, HCPs adopt a broader definition including genomic risk scores, lymph node involvement, and tumor grade and size. A dialogue to harmonize risk classification and testing eligibility across stakeholders is critical to address this disconnect and increase g testing in appropriate patients.