Rural Lung Cancer: Only 36% of Medicare Patients Had Gene Testing

Only about 1 in 3 older adults with advanced lung cancer living in rural parts of the U.S. had their tumor tested for gene changes that can point to a targeted treatment, according to a study published Nov. 5, 2026, in JAMA Network Open.

That matters because for many people with non-small cell lung cancer (NSCLC), the most common type of lung cancer, this kind of testing, often called biomarker or molecular testing, can reveal changes in genes such as EGFR or ALK. When one is found, patients may be able to take a targeted therapy, often a daily pill aimed at that specific change, instead of or before chemotherapy or immunotherapy.

Who Was Studied

Researchers at Johns Hopkins looked at Medicare records for 8,259 people ages 66 to 95 who lived in rural counties and were diagnosed with advanced (distant-stage) NSCLC between 2014 and 2019. They counted tests that look for gene changes in the tumor, including single-gene tests and larger panels, but not PD-L1, a separate test used to guide immunotherapy.

How Many Patients Were Tested

Overall, 35.9% of patients had molecular testing. About 18% were tested within the first month after diagnosis, rising to about 36% by six months. Among people with adenocarcinoma, the subtype in which actionable gene changes are most often found, about 56% were tested by six months.

Some groups were less likely to be tested. People with squamous cell lung cancer, another subtype, were tested at about one-third the rate of others, and people with both Medicaid and Medicare were about 29% less likely to be tested at any given point. Older age was also linked to less testing, while people diagnosed in later years were more likely to be tested.

What Testing Opened Up

Testing made a real difference in treatment. Among patients with Medicare drug coverage who lived at least six months, 120 of 1,114 people who were tested received a targeted therapy, compared with 16 of 932 who were not tested. Seeing both an oncologist and a surgeon or procedure specialist was strongly linked to getting tested, which suggests that access to specialists is part of the gap.

The study can't show why any one person wasn't tested. Some patients may not have had enough tumor tissue, may have been too sick, or may have chosen not to pursue treatment. And because the data end in 2019, testing has likely grown more common since then. The authors called for further study of solutions such as automatic testing at diagnosis and electronic reminders for doctors.

Making Sure Your Tumor Has Been Tested

If you have advanced NSCLC, it's reasonable to ask whether your tumor had a full biomarker panel and what it found. If there wasn't enough tissue, ask whether a blood-based test, sometimes called a liquid biopsy, is an option. People treated far from a major cancer center can also ask whether their sample can be sent out for testing so they don't need to travel.

A mother living with stage 4 lung cancer, who is on a targeted therapy after testing found an EGFR change, put it simply when she spoke with CURE earlier this year: "This cancer is not one size fits all." For a deeper look at what the different markers mean, read CURE's answers to common lung cancer biomarker questions or her full interview.

References

1. "Molecular Testing Among Patients With Advanced Non-Small Cell Lung Cancer in the Rural US." JAMA Network Open. Nov. 5, 2026.

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