A European survey coordinated by the EUSOMA initiative, answered by multidisciplinary teams in 39 countries, finds that basic services for early breast cancer care are almost universal, while important gaps remain in advanced imaging, genomic testing, targeted therapies, reconstruction and survivorship care.
What was known
Disparities between European countries in access to guideline-recommended early breast cancer care have been documented for years, but a detailed, service-by-service map was still missing.
What this work adds
PORTRAIT is a cross-sectional, clinician-reported access study run within a EUSOMA initiative. Between June and September 2024 a 49-item questionnaire —from diagnostics to supportive care— was emailed to the multidisciplinary teams of one expert breast centre in each of 42 European countries. Respondents provided a consensus perspective on the availability and public reimbursement of each service. Thirty-nine countries replied (93%), and the proportions with full, partial or no access were calculated.
Main results
Core diagnostics were widely available, but with cracks: MRI-guided biopsy was absent in 29% of countries and vacuum-assisted biopsy was fully reimbursed in only 66%. Genomic assays were unavailable in 14% of countries and not fully reimbursed in 35%. Public funding gaps were reported for PARP inhibitors (33%) and CDK4/6 inhibitors (26%). Immediate implant-based reconstruction and biological meshes lacked reimbursement in 21% and 33% respectively. Although hypofractionated radiotherapy was broadly available, 38% of countries still used per-fraction reimbursement. Psycho-oncology was limited in 35% of countries, fertility preservation in 46%, and patient-reported outcome measures (PROMs) were absent in 43%.
What it means
Basic services are nearly universal, but gaps persist in advanced services and in survivorship care. The authors present the survey as a tool to audit policies, align reimbursement and steward resources better. They also flag its main limitation: it reflects clinician perspectives from expert centres, so it probably portrays the best specialist care in each system rather than the national average, and it is not a population-representative estimate or a direct measure of patient outcomes.
A view from the breast unit
The picture highlights a point that is easy to miss in daily practice: basic tests are no longer the main bottleneck; advanced services and long-term care are. When psycho-oncology or fertility preservation depend on how they are funded, quality of care becomes uneven even with well-trained professionals.
Reference: Bonci EA, Di Micco R, Marotti L, Miraldo M, Rubio IT, Curigliano G, et al. Availability and public reimbursement of early breast cancer care across European expert centres: a PORTRAIT from an EUSOMA initiative. Breast, 2026. https://doi.org/10.1016/j.breast.2026.104859
