At 32 years old, I was living my best life. My daughter was a beautiful 3-year-old bundle of joy. I worked in government contracting where acronyms and jargon were the lay of the land. I never thought I’d hear as much jargon personally...until I was diagnosed with cancer. Terms like Elston score, subtype, and biomarker testing sounded intimidating and abstract. But I learned that biomarkers were more than just scientific buzzwords. They were keys to understanding my cancer and unlocking targeted treatments. In fact, I like to think of biomarkers as unique locks on cancer cells and the therapies as specialized keys. If we find the right key for the lock, we can unlock modalities that offer powerful, life-extending treatment options. This realization was empowering. It transformed my approach from feeling helpless to feeling hopeful and proactive. Now, I want every patient, especially those in communities of color like mine, to know about the power of biomarker testing and who should receive it.
What Are Biomarkers And How Does Testing Work?
Think of your cancer as having a fingerprint or a signature or something that makes it unique. That’s essentially what a biomarker is: a biological indicator of what’s driving your cancer. It could be a genetic mutation (a change in the DNA of the cancer cell, which is different from an inherited genetic mutation like BRCA1 or BRCA2 for breast cancer that happens before birth and is found through genetic testing), an extra copy of a gene, a protein on the cell’s surface, or other molecular changes that act like that “lock” in our analogy. For example, in some lung cancers, there’s a mutation in the EGFR gene inside the cancer tumor, and that’s a biomarker. In some breast cancers, the tumor makes too much of a protein called HER2; that’s another biomarker. Biomarker testing is the process of looking for these unique traits in your cancer, usually by analyzing a sample of your tumor (from a biopsy or surgery) or sometimes from your blood (a liquid biopsy).
Not only does biomarker testing help identify which specific drug or treatment would work best for a person’s specific cancer tumor, but it can also help determine things like risk or likelihood of recurrence. With this knowledge, a patient’s physician could potentially prescribe a treatment to lower that risk. Biomarker testing is used not only in the diagnosis and treatment steps of the continuum of care, but also in survivorship.
When doctors perform biomarker testing, they often use advanced methods like next-generation sequencing (NGS). NGS is like doing a broad sweep, reading through hundreds of genes in the tumor DNA to find any abnormalities. It’s as if they’re scanning all the possible locks on the cancer cell doors to see which ones are there. Other times, tests might be more specific, for instance, checking only for whether the HER2 “lock” is present because we have a specific key (Herceptin) for it, or checking the tumor for a PD-L1 protein “flag” that would suggest an immune therapy could work. The bottom line is that biomarker testing gathers critical information about what makes your cancer tick. Armed with that information, your medical team can select treatments that are tailored to those biomarkers, the keys to fit the locks.
Breaking Barriers: Equity in Biomarker Testing
As a Black woman and a cancer survivor, I know firsthand that access to life-saving innovations like biomarker testing isn’t equal. Despite its power to match patients with the best treatments, Black and Brown communities are less likely to receive this critical testing. In a 2022 study by Bruno and colleagues, only 44% of Black patients with advanced lung cancer received broad genetic testing, compared to 55% of White patients. Similar disparities exist in colorectal cancer, for which just 41.8% of Black patients received guideline-recommended biomarker tests versus 51.6% of White patients. These gaps aren’t about biology; they’re about access. Encouragingly, when care is equitable, as in Medicaid populations, racial disparities in testing disappear. This means change is possible. By improving education, training providers, and expanding policy-driven access, we can ensure that all patients regardless of race or income receive the personalized care they deserve. Biomarker testing isn’t a luxury; it’s a right.
Empowerment Through Knowledge: Advocate For Yourself
I firmly believe that knowledge is power in a cancer fight. Biomarker testing gave me knowledge that made me feel empowered. It guided my treatment choices and gave me a sense of control in an uncontrollable situation. I want every patient to feel that way. Especially for patients of color, one of the ways to break through the systemic barriers is to advocate for yourself. This isn’t always easy; doctors are experts, and it can feel awkward to question or request something. But remember, you are the expert on you, and you have every right to ask for the best possible care. Start by having a conversation with your doctor about biomarker testing. Here are some practical questions you can ask:
- “Has my tumor been tested for biomarkers or genetic mutations?” If not, ask if it should be. This signals to your team that you’re informed and interested in precision medicine
- “What were the results of my biomarker tests, and how do they affect my treatment options?” Make sure your doctor explains the findings in plain language. For example, if you have a certain mutation in the cancer tumor, what drug matches it? If no mutations were found, what does that mean for your care?
- “Are there targeted therapies or immunotherapies for my cancer’s profile?” This prompts discussion of treatments beyond standard chemotherapy. If you do have a biomarker, there may be an FDA-approved drug or a clinical trial available
- “Should I get a comprehensive genomic test (multigene panel)?” Depending on your cancer, it might be worthwhile to do broad testing (especially if initial tests didn’t find anything actionable, and you need more options)
- “Will my insurance cover these tests, and are there assistance programs if not?” Unfortunately, cost can be a barrier; however, many testing companies have financial assistance programs, and some nonprofits or research grants can help. Your care team can assist in navigating this
By asking these questions, you not only inform yourself, but you send a message to your healthcare providers that precision medicine matters to you. It can prompt them to double-check that all appropriate tests are ordered. Sometimes, especially in community clinics that see many patients, if a test isn’t standard, it might get overlooked, but a proactive patient can change that. If you feel your concerns aren’t being heard, don’t hesitate to seek a second opinion, preferably with an oncology center that has experience in molecular testing.
I want to leave you with this empowering message: you have a say in your cancer care. Biomarker testing is one of the tools that amplifies your voice. It takes the guesswork out of treatment and replaces it with personalization. Who should receive biomarker testing? In my view, anyone diagnosed with a cancer that has known biomarkers or targeted therapies, and that’s a growing list encompassing most advanced cancers. This is especially critical for patients in marginalized communities, who historically haven’t been offered these options as often. Make sure to discuss biomarker testing with your healthcare team. It could open the door to treatments that are effectively tailor-made for your cancer’s unique profile. In this journey, knowledge truly is power, and hope can be something we actively create by seizing every tool available. Biomarker testing is hope grounded in science, a beacon of light guiding us toward better, more effective care for everyone.
Sources
- Aggarwal C, Marmarelis ME, Hwang W-T, et al. Association between availability of molecular genotyping results and overall survival in patients with advanced nonsquamous non-small-cell lung cancer. JCO Precis Oncol. 2023;7:e2300191.
- Bhandari NR, Hess LM, He D, Peterson P. Biomarker testing, treatment, and outcomes in patients with advanced/metastatic non-small cell lung cancer using a real-world database. J Natl Compr Canc Netw. 2023;21:934-944.
- Bruno DS, Hess LM, Li X, et al. Disparities in biomarker testing and clinical trial enrollment among patients with lung, breast, or colorectal cancers in the United States. JCO Precis Oncol. 2022;6:e2100427.
- Hofmarcher T, Malmberg C, Lindgren P. A global analysis of the value of precision medicine in oncology: the case of non-small cell lung cancer. Front Med. 2023;10:1119506.
About the Author
Maimah Karmo is the founder of Tigerlily Foundation, a breast cancer survivor, and an advisory board member of Conquer.
