Policy priority
Equitable access to biomarker testing
Testing should be part of a clear care pathway — not something patients must discover and navigate alone.
We are calling for timely, publicly funded access to clinically appropriate tumour biomarker testing, connected to result interpretation, treatment planning, and trial consideration.
Biomarker testing can sometimes identify findings relevant to treatment or clinical-trial options. Not every result leads to a different treatment, and finding a potentially relevant biomarker does not guarantee access to a corresponding therapy.
A note on terms: “Biomarker testing” is broader than somatic genetic testing — biomarkers include gene changes, proteins, and other measurable features of a cancer. Testing a tumour is also different from testing for inherited (germline) changes. The two are connected, but they are not the same test. This priority is about tumour biomarker testing.
The problem
Whether a patient is offered testing — and how quickly results come back — depends heavily on where they live. Our Policy Builders of Tomorrow research (2025) mapped biomarker and genomic testing access across Canada and found a two-tier picture, including inside Atlantic Canada: Nova Scotia and New Brunswick have partial in-province testing capacity, while Prince Edward Island and Newfoundland and Labrador rely heavily on out-of-province referrals and send-out testing. Newfoundland and Labrador's provincial laboratory formulary entry for this testing dates from 2019 — the oldest provincial entry our research found.
Ontario shows what coordination looks like. Ontario's publicly funded comprehensive biomarker testing program rolled out from June 2021 and was implemented province-wide by 2021/22 — standardized funding and coordination, rather than a patchwork of individual arrangements.
A pan-Canadian evidence review found that 65% of patients who received comprehensive genomic profiling faced challenges in the process. And in pancreatic cancer, timing is not a detail: results that arrive after treatment decisions are made cannot inform them.
Our recommendations
These are the Foundation's recommendations — a proposed position we are putting to the organizations named. They are not commitments those organizations have made.
1
Establish clear testing eligibility and ordering pathways
We are asking cancer programs to specify:
- Who should be considered for testing
- At what point testing should be ordered
- Who is responsible for ordering it
- Which tests or panels are appropriate
- How testing is coordinated with inherited genetic testing
- What happens when a sample is insufficient or testing fails
This is not “every patient needs every test.” Published recommendations distinguish universal germline testing in pancreatic ductal adenocarcinoma from tumour molecular testing in particular clinical settings, including locally advanced or metastatic disease. Eligibility should follow the current evidence and guidelines.
2
Fund the full testing pathway
We are asking funders and cancer programs to fund more than the laboratory test itself:
- Pathology review and sample preparation
- Transfer of existing tissue between institutions
- Appropriate repeat sampling, where clinically justified
- Laboratory testing
- Interpretation and communication of results
- Necessary genetics referrals
These are the costs we are asking to have funded. Which of them are covered today — and which are not — varies by jurisdiction; our research tracks that province by province rather than assuming a single national picture.
3
Return results in time to inform decisions
We are asking cancer programs and laboratories for:
- Published turnaround expectations
- Tracking from ordering through result communication
- Escalation routes for delayed or inadequate samples
- Clear explanations of whether results affect the current plan, or future options
We are not proposing a national deadline here. Turnaround targets should be developed with clinical and laboratory input — with pancreatic cancer's short treatment windows kept in view.
4
Connect findings to appropriate next steps
We are asking for access to clinical interpretation, and a documented plan explaining:
- Whether the result changes treatment considerations
- Whether a clinical-trial referral may be relevant
- Whether inherited testing or genetic counselling is indicated
- Whether no immediate change is recommended
A tumour finding can have hereditary implications, but tumour testing alone does not establish that a change was inherited. A BRCA finding in a tumour, for example, may prompt germline testing to clarify that question.
What testing can — and cannot — change
- Testing can inform real decisions. Findings may be relevant to treatment options or clinical-trial consideration, and can shape the plan a care team discusses with a patient. (Canadian Cancer Society)
- A result does not guarantee a therapy. Finding a potentially relevant biomarker is not the same as accessing a corresponding treatment — drug approval and public funding are separate questions. (Canadian Cancer Society)
- Not every result changes treatment. Many results confirm the current plan, or inform future options, rather than changing today's treatment. A useful result may inform a discussion without producing a treatment change. (The role of molecular testing in pancreatic cancer)
- Tumour and inherited testing answer different questions. A change found in a tumour may be acquired, or potentially inherited; only germline testing can establish an inherited change — which can also matter for relatives. (U.S. National Cancer Institute)
- Scope matters. Published recommendations distinguish who should receive which testing, and in which clinical settings — testing policy should follow that evidence. (PMC review · NCCN guidelines, JNCCN)
Our work on this priority
In development
Building testing into the national care pathway
Through Christopher Cutler's seat on the working committee developing national care pathways alongside Craig's Cause Pancreatic Cancer Society, the Foundation is building biomarker testing into the pathway work — so testing is part of the expected sequence of care, not an add-on patients must discover and request themselves.
Our national guidelines and care pathways priority →
Published
Provincial research on testing access
Our Policy Builders of Tomorrow national audit and provincial report card examined biomarker and genomic testing access in every province — laboratory capacity, funding arrangements, and referral routes — including the two-tier picture inside Atlantic Canada described above.
See the report card →
Submitted
Budget 2026 pre-budget asks
The Foundation's Budget 2026 pre-budget submission asked the federal government to invest $50 million over five years in pan-Canadian biomarker testing equity — Atlantic laboratory infrastructure and workforce, turnaround times aligned to pancreatic cancer treatment windows, specimen transport, and digital pathology.
Progress log
Responses to these recommendations
October 2026 — Recommendations published on this page. Responses, commitments, and remaining gaps will be recorded here as they arrive.
How progress will be measured
Access, not just test volume. The measures we propose — to be developed with clinical and laboratory input:
- The proportion of eligible patients offered testing
- Time from ordering to a usable result
- Rates of insufficient samples
- Whether results were discussed with the patient
- Whether a recommended referral was completed
- Differences by geography and treatment centre
Looking for information about your own care?
This page sets out the changes we are advocating for. Our patient guide explains what biomarker testing is, how it differs from inherited genetic testing, what results can mean, and the questions to ask your care team.
What is biomarker testing? →