As precision medicine continues to reshape cancer care, ensuring equitable access to genomic testing remains a critical priority. New research presented at ISPOR 2026 highlights how the adoption of homologous recombination repair (HRR) genetic testing has evolved among patients with metastatic prostate cancer in community oncology settings across the United States. In this conversation with BioPharma Boardroom, Helen Latimer shares key findings from the study, explores persistent barriers to genomic testing, and discusses how real-world evidence can help healthcare systems design more inclusive precision oncology strategies. Her insights underscore the growing importance of integrated data systems, standardized care pathways, and evidence-based approaches to advancing health equity in cancer treatment.

Q: What were the most significant findings from your analysis of racial trends in HRR genetic testing among metastatic prostate cancer patients?

• A: Overall, we observed a substantial increase in HRR testing over the study period – increasing from less than 5% prior to 2019 to just over 40% in 2023 and 2024 – which generally reflected the broader adoption of genomic testing in the community setting aligned with the approval dates of targeted therapies, specifically PARP inhibitor therapies. 
• Secondly, we also stratified rates by race and found that testing rates were broadly similar between white and black patients for most of the study period. with only small differences observed in more recent years. Both findings suggest that there is meaningful progress in the overall uptake for biomarker testing in metastatic prostate cancer although there's still the potential for improvement in increasing testing overall within the community oncology setting. 

Q: Have you observed measurable improvements in testing equity between 2015 and 2024, and where do disparities still remain?

• A: Over most of the study period, we found that testing rates were extremely similar between white and black patients, which is encouraging from an equity perspective. In recent years, we did observe slightly higher rates among white patients, but the differences were relatively modest. However, we did see lower uptake overall in our other race category, which is comprised of smaller and more heterogeneous populations that we didn't have the sample size to analyze as their own standalone groups so it’s important to point out that limitation and the finding should be interpreted cautiously. 
• Largely the data from our study suggests that these disparities are narrowing in this setting in part because of advancements in access to genetic testing as well as technological advancements, specifically structured EHR data databases that prompt physicians to order testing for eligible patients in a more standardized way.

Q: What systemic factors continue to influence unequal access to genomic testing across patient populations?

• A: This is an important question – our study wasn't designed to evaluate causal drivers, but we know from other studies and literature in general that there are systemic level factors that play an important role in shaping testing patterns and access to care. We know, for example, that patients from lower socioeconomic backgrounds, who are underinsured or patients in rural areas, may have limited access to genomic testing and subsequently targeted treatments. 
• It’s also important to point out that this analysis reflects patients from a large integrated EHR network in the community setting which features standardized workflows, EHR infrastructure and access to testing resources that, um, may experience more consistent testing practices and equitable access to genetic testing, although there's still room for improvement in testing rates overall.

Q: How can real-world evidence better support initiatives aimed at improving diversity and equity in oncology care?

• A: Real-world evidence plays a really important role in providing visibility into how care is delivered across diverse patient populations outside of the clinical trial setting. We know that historically clinical trials have underrepresented diverse populations so real-world evidence is an opportunity to fill that gap and provide valuable information for patients able to receive genetic testing, the results of that testing, and if they're able to access targeted treatments, the outcomes for patients on targeted treatments. 
• Real-world data generally supports equity-focused initiatives by helping stakeholders measure disparities, track changes over time, and assess the impact of interventions that can translate into more consistent care delivery in routine practice.

Q: What lessons from this research could help healthcare systems design more inclusive precision medicine strategies?

• A: A key takeaway is that equitable uptake of biomarker or genetic testing can be achievable within certain care models, particularly those with strong system level support. As I mentioned, the EHR data used for this analysis suggests that integrated data systems can help improve standardized approaches to testing and may reduce variability and in care delivery across different racial populations. 
• At the same time, our study highlights that overall testing rates can still be improved in this patient population and it's important to incorporate a precision medicine approach, not only equity, across these different racial and ethnic subgroups to ensure that all eligible patients are consistently identified and tested.