Coming off Colorectal Cancer Awareness Month, the conversation around rising cases, younger patients, and late-stage diagnoses is intensifying. NCCN has updated its guidance. New targeted options—including one approved April 8, 2025—are here.
And yet – biomarker testing still isn’t happening early or consistently enough, especially in community settings.
This edition of Compass uses mCRC as the lens—but the solutions apply across many tumor types. Lung, breast, melanoma, hematologic cancers…different biomarkers, same barriers.
Biomarker Testing: A Case Study in Missed Opportunity
Biomarker testing should be a crown jewel of precision oncology. Find the right mutation, match the therapy, improve outcomes.
The problem? It’s not happening at scale. Not even close.
Despite NCCN recommending universal testing in mCRC, uptake in community settings remains alarmingly low. Here is what’s recommended for suspected or proven metastatic adenocarcinoma:
“RAS and BRAF mutations; HER2 amplifications; MMR or MSI status (if not previously done). Testing should be conducted as part of broad molecular profiling, which would identify rare and actionable mutations and fusions such as POLE/POLD1, RET, and NTRK.”
This is where we are:
Testing at diagnosis lays the foundation for faster second-line decisions, clinical trial access, sequencing—and now it may even influence front-line options.
Waiting risks delay—or worse, inaction.
Also, this isn’t just about mCRC. Lung. Breast. Melanoma. Hematological Cancers…. Different biomarkers, same barriers.
4 Problems. 4 Fixes. (No Capital Budget Needed)
👉 “Not enough tissue.”
Small biopsies, excessive IHC, and fragmented care reduce available material.
Start at the source. Ensure proceduralists collect enough for both diagnosis and NGS. Align with pathology to limit unnecessary IHC and preserve slides. If tissue is inadequate, trigger liquid biopsy early—can salvage up to 70% of cases.
Build a fallback protocol. Let the EHR prompt the next step.
👉 “It takes too long.”
Manual orders slow everything down. Reflex testing is the clearest fix—yet underused.
Shift the trigger upstream. Let pathology initiate testing based on predefined criteria. Embed panels into the EHR.
Reflex testing speeds results, boosts rates, and cuts delays. Still, 60% of practices don’t use it.
It takes an MDT agreement, a protocol, and minimal training. But once it’s live, it runs itself—and delivers impact.
👉 “My patients may not be able to afford this.”
Medicare and most private payers cover broad-panel NGS—with the right paperwork.
Build a CPT and prior auth cheat sheet for your top payers. Front-load benefit verification. Start the cost conversation early—before the test is ordered.
👉 “We don’t have the resources”
You don’t need more people—just clearer ownership. Even with solid workflows, testing stalls when no one is explicitly responsible.
Assign a Biomarker Testing Navigator. Not a new hire—just someone already on the team who’s empowered to follow through. This person tracks sample adequacy, confirms orders, troubleshoots delays, and makes sure results reach the right hands.
Ownership doesn’t need a title. It needs clarity.
Biomarker testing must stop being a “nice-to-have.” It needs to be operationalized as a core step in care delivery.
Make it Happen: Where to start?
You’ve seen the barriers—and how to fix them.
Now it’s time to make it real.
We’ve created a draft step-by-step implementation checklist with small, scalable steps you can take now. It’s not perfect—but it’s a good starting point for you to adapt to your practice and systems.
This guide is built for action—across tumor types—starting with mCRC. Download it. Customize it. Share it. Bring it to your next tumor board discussion.
Because this isn’t just a colorectal cancer problem—it’s an oncology-wide opportunity waiting to be operationalized.
The tools exist.
The coverage is in place.
The therapies are ready.
Let’s make testing happen!
Already doing this well?
Thank you. You’re ahead of the curve. Now share this with a colleague or practice that’s still catching up. What’s routine for you could be a game-changer for someone else.
And their patients.
If you found this helpful—or have ideas for future topics—just hit reply and let me know. I’d truly love to hear from you!
Your replies also help ensure these updates land in your inbox every time.
Warmly,
Shruti Agarwal, PhD
Founder, Together4Cancer
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The Compass is your practical briefing on what’s working in oncology care – strategy, science, and systems. No fluff. Just implementation.