Despite patient interest and marketing, clinical experts are cautious about routine ctDNA use in endometrial cancer. They struggle with interpreting results, worrying that a positive test could lead to unnecessary anxiety and premature or excessive treatment without clear evidence of benefit.

Despite emerging trial data, clinicians are not yet ready to change therapy based on ctDNA positivity alone. Key concerns cited include the absence of a proven survival benefit from early intervention, the potential to use future treatment lines prematurely, and overall feasibility. The consensus is that while promising, the technology is not yet ready for routine clinical decision-making.

While not yet validated, ctDNA is being used by clinical experts as a de-escalation tool to provide confidence when stopping long-term maintenance therapies like PARP inhibitors. This novel application focuses on reducing treatment burden rather than solely detecting disease progression.

While ctDNA testing offers powerful prognostic information, some patients decline it. The key reason is the anxiety associated with receiving a positive result after adjuvant therapy when there is no standard-of-care intervention for MRD positivity. For these patients, the psychological burden of knowing about likely recurrence without a clear action plan outweighs the benefit.

An expert oncologist advises against ordering ctDNA tests that merely provide a "good or a bad feeling" about prognosis. The most valuable use is when a positive or negative result clearly dictates a clinical action, such as when to stop or restart adjuvant therapy.

While useful for initial genomic screening, using circulating tumor DNA (ctDNA) to monitor treatment response in the metastatic setting is discouraged. A positive ctDNA result in a patient with negative scans can create significant patient anxiety without a clear clinical action, as treatment decisions are still typically based on radiographic progression.

While patients increasingly ask about ctDNA, clinicians are hesitant to use it for treatment decisions in ovarian cancer management. A rising ctDNA level may prompt more vigilant surveillance but does not yet trigger treatment initiation, as its correlation with survival outcomes is unproven.

An 80-year-old patient and his wife wisely questioned the value of a circulating tumor DNA (ctDNA) test by asking, "if you're not going to act on it, why would we send this?" This serves as a powerful reminder for clinicians to only order tests that will directly influence treatment decisions, respecting patient-centered, high-value care.

While valuable in research, using circulating tumor DNA (ctDNA) to monitor HER2+ lung cancer patients in clinic can be counterproductive. It often induces patient anxiety due to fluctuations and high false-negative rates, and the results are not yet actionable for guiding treatment decisions like initiating a therapy holiday. For now, it's a tool that can add more stress than clarity.