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Anitra Greivule
Head of Genekor Latvia
Twenty years ago, the main principle in breast cancer treatment was simple: it was better to treat more intensively than to miss the opportunity to defeat the disease. When a doctor had doubts, chemotherapy was considered the safer choice. This was the medical reality at a time when treatment decisions were based primarily on tumour size, lymph node involvement, the patient’s age and other clinical indicators.
This approach is rapidly changing in modern oncology. Today, the most important question is no longer how to treat more. The most important question is how to treat more precisely.
This is the essence of precision, or personalised, medicine: selecting treatment based not on general assumptions, but on the biology of the individual patient’s disease and on scientific evidence. This is not a vision of the future. It is already part of everyday clinical practice in many European countries.
Latvia has also begun moving in this direction. The results of the pilot project conducted at Riga East University Hospital confirm what international studies have already demonstrated: in patients with early-stage breast cancer whose growth is driven by hormones and which does not have elevated HER2 protein activity—medically referred to as hormone receptor-positive, HER2-negative breast cancer—it is possible to assess much more precisely whether chemotherapy will genuinely provide a benefit in the individual patient’s situation.
During the pilot project, genomic testing was performed for 208 patients. The results were compelling: in 76% of cases, the test results supported a decision not to administer chemotherapy.
This is more than a medical fact. It represents hundreds of women who do not have to undergo treatment associated with significant adverse effects when it provides them with no additional benefit. It means fewer prolonged periods of incapacity for work, fewer physical and emotional consequences, and greater opportunities to return sooner to their families, work and everyday lives.
This is where one of the most significant changes in modern oncology lies: more intensive treatment is not always better treatment.
There is still a widespread perception that chemotherapy is almost inevitable after breast cancer surgery. At the time of diagnosis, many patients assume that hair loss, nausea, fatigue and months of treatment will naturally follow. However, in recent years, science has fundamentally changed our understanding of how treatment decisions should be made.
If a therapy that provides no additional benefit to a particular patient can be safely avoided, this is not a compromise. It is the goal of modern medicine. One of the most internationally recognised tools for making such treatment decisions is the Oncotype DX®genomic test, which analyses the biology of the tumour and helps the physician assess whether the individual patient will genuinely benefit from chemotherapy. The use of this test was also evaluated in the Latvian pilot project.
Approximately 1,200 women are diagnosed with breast cancer in Latvia every year. Around 80% of cases involve this type of early-stage breast cancer—a patient group for whom international clinical guidelines recommend genomic testing to assess the potential benefit of chemotherapy. International data indicate that approximately 80% of these patients derive no additional benefit from chemotherapy.
This raises a very simple question: if evidence-based diagnostic tools are available to help avoid unnecessary treatment, why are they still not equally accessible to all patients?
Today, for many women in Latvia, access to this opportunity depends not only on medical indications but also on their personal financial means. Some patients pay for the test themselves or seek financial support, while others do not have this option. Consequently, access to diagnostics recommended by international clinical guidelines is unequal. A patient’s financial circumstances should not determine whether her doctor has access to the information needed to select the most appropriate treatment for her.
It is often assumed that introducing more advanced diagnostic methods creates an additional burden on the healthcare budget. The results of the Latvian pilot project demonstrate the opposite.
The KPMG economic analysis confirms that more precise diagnostics are not only medically justified but also economically sound. Every euro invested in genomic testing generates an economic return of more than two euros by reducing the costs associated with unnecessary chemotherapy, incapacity for work and treatment-related adverse effects.
In essence, this means that the discussion is not solely about allocating additional funding to healthcare. It is also about using the resources already available more intelligently.
Precision medicine is not a luxury. It is the logical evolution of modern medicine—an opportunity to treat each person as precisely as possible and to avoid therapies that provide no additional benefit in their particular situation.
The Latvian pilot project has demonstrated that this approach also works within our healthcare system and can benefit both patients and the state. The next step is to ensure that genomic testing is systematically available to patients for whom it is medically justified, and that treatment decisions are determined by medical indications rather than by the patient’s financial means.
Sources
KPMG report https://aslimnica.lv/wp-content/uploads/2026/09/Parskats-par-ekonomisko-un-veselibas-ieguvumu-analizi-Oncotype_12022026.pdf (sadaļā – https://aslimnica.lv/veza-centrs/specialistiem/)
1) Centre for Disease Prevention and Control of Latvia (SPKC) — breast cancer incidence/statistics
The official SPKC oncology database provides newly registered malignant tumour cases, including incidence per 100,000 population.
SPKC – Newly registered cancer cases (ONKO030)
2) NCCN Clinical Practice Guidelines in Oncology – Breast Cancer NCCN Guidelines – Breast Cancer
3) Published clinical evidence on genomic testing / Oncotype DX® the prospective TAILORx and RxPONDER studies: