NEXT-GENERATION SEQUENCING (NGS) is a type of molecular profiling that analyzes many genetic changes in cancer cells at once. People with advanced or metastatic cancer often receive this testing to learn whether their cancer has any genetic abnormalities that might be treated with a targeted therapy. For example, in non-small cell lung cancer, NGS may identify an EGFR mutation, an ALK rearrangement or a ROS1 fusion that can help doctors choose a treatment; in other cancers, it may reveal rare tumor changes, such as NTRK fusions, which are targetable across cancer types.
“NGS testing may help patients in various ways. It will provide information to their oncologist with regard to the best treatment or prognostic information that can show whether the cancer has certain genes or alterations that are associated with aggressive or slower-growing disease,” says Umang Swami, a medical oncologist at the University of Utah Huntsman Cancer Institute in Salt Lake City. “Information revealed from testing also may provide opportunities for patients to explore new treatments in clinical trials down the road.”
In a study published April 7, 2026, in JAMA Network Open, Swami and colleagues analyzed a U.S. health records database to measure trends in the length of time between an advanced or a metastatic cancer diagnosis and NGS testing. The study included data from more than 63,000 people who had been diagnosed from 2018 through 2022 with metastatic breast, prostate, colorectal or pancreatic cancer, or advanced non-small cell lung cancer. The median time to testing varied by cancer type from about one month for lung cancer to nearly one year for prostate cancer. In addition, for some of these cancers, people who were Black or Hispanic, who were on Medicare or Medicaid, or who had lower socioeconomic status waited longer for NGS than their peers.
Swami was also an author of a 2024 study that found less than half of people diagnosed with metastatic prostate or advanced urothelial cancer from 2015 through 2022 underwent genomic testing. That work found similar testing lags among patients based on race and insurance type.
While genomic testing rates improved among all five cancer types in the 2026 study, many people diagnosed with advanced or metastatic cancer still did not receive NGS, including about 63% of people with prostate cancer. Swami recently spoke with Cancer Today about the findings.
CT: Your study focused on people with advanced cancer. Is NGS used for people who have earlier stages of the disease too?
SWAMI: NGS can be ordered for any tumor type. It can be localized cancer; it can be metastatic cancer. But the cancers we picked for the study have treatments that are approved based on NGS testing. This test is standard for almost all advanced cancers now.
CT: How do you use NGS testing in practice?
SWAMI: In our clinics, we provide sequencing to patients with advanced disease on their first visit. We offer tumor sequencing and ctDNA (circulating tumor DNA) sequencing. We also do germline testing to look for inherited cancer predisposition. Oncologists are generally aware that they need to order genomic sequencing because there are Food and Drug Administration-approved therapies for people whose cancer has certain alterations.
CT: When do you use ctDNA versus tumor DNA testing?
SWAMI: As cancer cells die or are destroyed, they release DNA into the bloodstream, which can be picked up with advanced technology, and it can be sequenced to find out what alterations are in the tumor.
Tumor testing requires a tumor tissue sample, which means you need to put a needle in the tumor itself or cut it out through a small surgical incision, so it’s more invasive. But ctDNA testing is just a blood draw. Tumor testing is considered the better testing method; it’s more confirmatory. Having said that, there are certain cancers, like metastatic prostate cancer, where the tumor often grows in the bones, where it’s hard to get a biopsy.
CT: How long does testing take?
SWAMI: It depends. If we are doing ctDNA, the results may be back within seven to 10 days, and if it’s the tumor tissue, it may take maybe two to four weeks.
CT: Why might Black and Hispanic patients have experienced a longer time to testing?
SWAMI: It’s possible that there is some suspicion or low confidence with regard to health care services because of past history. Also, there may be some other situations, such as socioeconomic reasons, or other challenges with regard to access to care.
CT: Is NGS testing becoming more accepted?
SWAMI: Many first-line treatments are based on these NGS testing results. There are now so many testing companies, it has democratized this whole field. The costs have come down drastically with advances in science.
CT: What can be done to make genomic testing access more equitable?
SWAMI: If it’s possible, with regard to the insurance companies, as well as these testing companies, to provide upfront cost estimates, that will be a huge relief for patients and will inspire a lot of confidence among oncologists to do these tests.
We also need to provide more information to the patients, including through patient advocacy or support groups, to make people more aware of genomic testing.
