Access to molecular classification in endometrial cancer recommended by ESGO–ESTRO–ESP guidelines: multi-national survey in Eastern Europe
Advances in tumor biology have transformed endometrial cancer management. Since 2021, ESGO-ESTRO-ESP (European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology-European Society of Pathology) guidelines have incorporated molecular classification, which is essential in the 2025 update. Its implementation in Eastern Europe remains unclear. This study evaluated the availability, reimbursement, and integration of molecular classification at national and institutional levels. A 2-phase cross-sectional online survey was conducted from December 2024 to September 2025. National coordinators from 17 European Society of Gynaecological Oncology-affiliated countries reported on access, reimbursement, and guidelines. A second survey targeted 67 treatment centers to assess institutional practices. Full molecular profiling (p53-abnormal, POLE-ultra-mutated, mismatch repair-deficient) was available in 29.4% of countries, with partial access in 70.6%. Lack of reimbursement and accredited laboratories were the main barriers. At least 1 test was publicly funded in 58.8% of countries: p53 and mismatch repair-deficient immunohistochemistry in 70.0% and POLE-ultra-mutated next-generation sequencing in 29.4%. National guidelines existed in over half of the countries, but few included molecular classification. At the institutional level, testing was routine in 41.0% of centers, selective in 27.9%, and unavailable in 31.1%. Overall, 55.8% reported access via local or external laboratories. Comprehensive classification was significantly more available in settings with national/public reimbursement (79.2% vs 18.9%, p < .0001). POLE-ultra-mutated testing was more accessible in private than public hospitals (42.9% vs 33.3%, p = .006), while p53 immunohistochemistry was more common in high-volume centers (97.5% vs 76.2%, p = .01). Access to molecular classification in Eastern Europe remains limited because of insufficient reimbursement and laboratory resources. Addressing these disparities is essential to support equitable treatment and improve outcomes.
