Access to genetic testing in oncology

Access to genetic testing in the field of cancer is becoming increasingly important as discoveries are made in basic, translational and clinical research. It has, thus, been possible to demonstrate that common cancers, whose diagnosis was based essentially on anatomical location and anatomical pathology in the past, were in fact a collection of rare diseases defined by molecular alterations. These alterations, such as mutations, amplification or fusion, require the use of sophisticated tools such as Next Generation Sequencing (NGS). Beyond a better characterisation of diseases, this molecular analysis allows the definition of targets accessible to specific drugs, which constitutes the basis of personalised medicine in cancerology. Even if the clinical evaluation of certain molecules has not always been successful, the improved survival of lung cancer patients, for example, confirms the validity of this concept. The problem is now access to these tests, which are not covered by effective specific mechanisms as are expensive molecules or implantable devices, which leads to inequalities in the treatment of cancers on French territory, posing a real ethical problem.