Clinical application of molecular classification of carcinoma endometrium in India

Objectives: Molecular classification of endometrial cancer (EC) requiring molecular testing and immunohistochemistry (IHC) is a new way forward for personalized medicine. However, due to limited availability and high cost, incorporating molecular classification into clinical practice has been challenging, especially in low-resource countries. We tried to analyze the clinical application of molecular classification of EC among Indian oncologists. Material and Methods: We conducted a nationwide online survey among healthcare professionals directly managing EC patients. A total of 129 clinicians responded to 14 questions. Results: Out of 129, the majority 55 clinicians (42.6%) were gynecologists, and 43 clinicians (33.3%) were gynecologists. Most clinicians (41.1%) get only IHC markers done- p53 and mainly mismatch repair, while only 10.9% get the complete profile with next-generation sequencing (NGS). About 33.3% of clinicians got it done on the final histopathology specimen, while 60.5% of clinicians felt that this test should be done on pre-operative endometrial biopsy, and the rest 6.2% of clinicians got it done at the time of relapse/recurrence/residual disease. Unfortunately, 20.9% of clinicians could not get these done due to a lack of facilities. If the molecular markers are available pre-operatively, the majority, i.e., 42.6% of clinicians, agreed to limit surgery of polymerase ε m like avoiding complete lymphadenectomy, aggressive surgery for P53 positive, like doing complete lymphadenectomy and omentectomy, and avoiding a minimally invasive route. However, 63.6% of clinicians want to wait for further prospective studies, and only 4% feel that current data are sufficient to change the management. Conclusion: Our findings underscore the urgent need for wider accessibility, affordability, and standardization of molecular testing in India. The heterogeneity in clinical practice observed highlights a policy gap where national guidelines must adapt to local realities by recommending cost-effective testing strategies, starting with IHC and then extending to NGS where feasible. To move Indian oncology closer to global standards of personalized cancer care, future national health policies should focus on subsidizing molecular diagnostics, ensuring uniform laboratory quality, and supporting prospective multicentric trials to generate India-specific evidence that can guide risk-adapted surgical and adjuvant treatment strategies.