{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:01:19Z","timestamp":1790312479241,"version":"4.1.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100021316","name":"AstraZeneca United States","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100021316","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Breast Cancer Res Treat"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1007\/s10549-026-08060-x","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:39:20Z","timestamp":1788935960000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world estrogen receptor alpha 1 (ESR1) testing patterns and results for ER+\/HER2- metastatic breast cancer in the United States, 2018\u20132024"],"prefix":"10.1007","volume":"219","author":[{"given":"Jane","family":"Meisel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayush","family":"Kris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Roose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"8060_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin 74:229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","journal-title":"CA: Cancer J Clin"},{"key":"8060_CR2","unstructured":"National Cancer Institute Female (2026) breast cancer \u2014 cancer stat facts. https:\/\/seer.cancer.gov\/statfacts\/html\/breast.html. Accessed 22 Jan"},{"key":"8060_CR3","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3322\/caac.21871","volume":"75","author":"RL Siegel","year":"2025","unstructured":"Siegel RL, Kratzer TB, Giaquinto AN et al (2025) Cancer statistics, 2025. CA: A Cancer. J Clin 75:10\u201345. https:\/\/doi.org\/10.3322\/caac.21871","journal-title":"J Clin"},{"key":"8060_CR4","unstructured":"National Cancer Institute Female breast cancer subtypes \u2014 cancer stat facts. https:\/\/seer.cancer.gov\/statfacts\/html\/breast-subtypes.html. Accessed 24 June 2025"},{"key":"8060_CR5","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1016\/s0960-9776(19)31118-x","volume":"48","author":"JT Lei","year":"2019","unstructured":"Lei JT, Anurag M, Haricharan S et al (2019) Endocrine therapy resistance: new insights. Breast 48:S26\u2013S30. https:\/\/doi.org\/10.1016\/s0960-9776(19)31118-x","journal-title":"Breast"},{"key":"8060_CR6","doi-asserted-by":"publisher","first-page":"181","DOI":"10.2174\/156802606776173483","volume":"6","author":"E Ariazi","year":"2006","unstructured":"Ariazi E, Ariazi J, Cordera F, Jordan V (2006) Estrogen receptors as therapeutic targets in breast cancer. Curr Top Med Chem 6:181\u2013202. https:\/\/doi.org\/10.2174\/156802606776173483","journal-title":"Curr Top Med Chem"},{"key":"8060_CR7","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1056\/nejmoa1607303","volume":"375","author":"RS Finn","year":"2016","unstructured":"Finn RS, Martin M, Rugo HS et al (2016) Palbociclib and letrozole in advanced breast cancer. N Engl J Med 375:1925\u20131936. https:\/\/doi.org\/10.1056\/nejmoa1607303","journal-title":"N Engl J Med"},{"key":"8060_CR8","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1038\/s41523-018-0097-z","volume":"5","author":"S Johnston","year":"2019","unstructured":"Johnston S, Martin M, Leo AD et al (2019) MONARCH 3 final PFS: a randomized study of abemaciclib as initial therapy for advanced breast cancer. npj Breast Cancer 5:5. https:\/\/doi.org\/10.1038\/s41523-018-0097-z","journal-title":"npj Breast Cancer"},{"key":"8060_CR9","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1093\/annonc\/mdy155","volume":"29","author":"GN Hortobagyi","year":"2018","unstructured":"Hortobagyi GN, Stemmer SM, Burris HA et al (2018) Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol 29:1541\u20131547. https:\/\/doi.org\/10.1093\/annonc\/mdy155","journal-title":"Ann Oncol"},{"key":"8060_CR10","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.ccell.2020.03.009","volume":"37","author":"AB Hanker","year":"2020","unstructured":"Hanker AB, Sudhan DR, Arteaga CL (2020) Overcoming endocrine resistance in breast cancer. Cancer Cell 37:496\u2013513. https:\/\/doi.org\/10.1016\/j.ccell.2020.03.009","journal-title":"Cancer Cell"},{"key":"8060_CR11","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s12672-017-0306-5","volume":"9","author":"SM Pejerrey","year":"2018","unstructured":"Pejerrey SM, Dustin D, Kim J-A et al (2018) The impact of ESR1 mutations on the treatment of metastatic breast cancer. Horm Cancer 9:215\u2013228. https:\/\/doi.org\/10.1007\/s12672-017-0306-5","journal-title":"Horm Cancer"},{"key":"8060_CR12","doi-asserted-by":"publisher","first-page":"74448","DOI":"10.18632\/oncotarget.12950","volume":"7","author":"F Clatot","year":"2016","unstructured":"Clatot F, Perdrix A, Augusto L et al (2016) Kinetics, prognostic and predictive values of ESR1 circulating mutations in metastatic breast cancer patients progressing on aromatase inhibitor. Oncotarget 7:74448\u201374459. https:\/\/doi.org\/10.18632\/oncotarget.12950","journal-title":"Oncotarget"},{"key":"8060_CR13","doi-asserted-by":"publisher","first-page":"313ra182","DOI":"10.1126\/scitranslmed.aac7551","volume":"7","author":"G Schiavon","year":"2015","unstructured":"Schiavon G, Hrebien S, Garcia-Murillas I et al (2015) Analysis of ESR1 mutation in circulating tumor DNA demonstrates evolution during therapy for metastatic breast cancer. Sci Transl Med 7:313ra182. https:\/\/doi.org\/10.1126\/scitranslmed.aac7551","journal-title":"Sci Transl Med"},{"key":"8060_CR14","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1001\/jamaoncol.2016.1279","volume":"2","author":"S Chandarlapaty","year":"2016","unstructured":"Chandarlapaty S, Chen D, He W et al (2016) Prevalence of ESR1 mutations in cell-free DNA and outcomes in metastatic breast cancer: a secondary analysis of the BOLERO-2 clinical trial. JAMA Oncol 2:1310\u20131315. https:\/\/doi.org\/10.1001\/jamaoncol.2016.1279","journal-title":"JAMA Oncol"},{"key":"8060_CR15","doi-asserted-by":"publisher","first-page":"pkac060","DOI":"10.1093\/jncics\/pkac060","volume":"6","author":"CJ Kinslow","year":"2022","unstructured":"Kinslow CJ, Tang A, Chaudhary KR, Cheng SK (2022) Prevalence of estrogen receptor alpha (ESR1) somatic mutations in breast cancer. JNCI Cancer Spectr 6:pkac060. https:\/\/doi.org\/10.1093\/jncics\/pkac060","journal-title":"JNCI Cancer Spectr"},{"key":"8060_CR16","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13058-020-1246-5","volume":"22","author":"A Zundelevich","year":"2020","unstructured":"Zundelevich A, Dadiani M, Kahana-Edwin S et al (2020) ESR1 mutations are frequent in newly diagnosed metastatic and loco-regional recurrence of endocrine-treated breast cancer and carry worse prognosis. Breast Cancer Res 22:16. https:\/\/doi.org\/10.1186\/s13058-020-1246-5","journal-title":"Breast Cancer Res"},{"key":"8060_CR17","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1038\/s41523-024-00617-7","volume":"10","author":"N Chaudhary","year":"2024","unstructured":"Chaudhary N, Chibly AM, Collier A et al (2024) CDK4\/6i-treated HR+\/HER2- breast cancer tumors show higher ESR1 mutation prevalence and more altered genomic landscape. NPJ Breast Cancer 10:15. https:\/\/doi.org\/10.1038\/s41523-024-00617-7","journal-title":"NPJ Breast Cancer"},{"key":"8060_CR18","doi-asserted-by":"publisher","first-page":"3246","DOI":"10.1200\/jco.22.00338","volume":"40","author":"F-C Bidard","year":"2022","unstructured":"Bidard F-C, Kaklamani VG, Neven P et al (2022) Elacestrant (oral selective estrogen receptor degrader) versus standard endocrine therapy for estrogen receptor\u2013positive, human epidermal growth factor receptor 2\u2013negative advanced breast cancer: results from the randomized phase III EMERALD trial. J Clin Oncol 40:3246\u20133256. https:\/\/doi.org\/10.1200\/jco.22.00338","journal-title":"J Clin Oncol"},{"key":"8060_CR19","unstructured":"U.S. Food and Drug Administration FDA approves elacestrant for ER-positive, HER2-negative, ESR1-mutated advanced or metastatic breast cancer | FDA. https:\/\/www.fda.gov\/drugs\/resources-information-approved-drugs\/fda-approves-elacestrant-er-positive-her2-negative-esr1-mutated-advanced-or-metastatic-breast-cancer. Accessed 24 Mar 2026"},{"key":"8060_CR20","doi-asserted-by":"publisher","first-page":"3423","DOI":"10.1200\/jco.23.00638","volume":"41","author":"HJ Burstein","year":"2023","unstructured":"Burstein HJ, DeMichele A, Somerfield MR, Henry NL (2023) Testing for ESR1 mutations to guide therapy for hormone receptor\u2013positive, human epidermal growth factor receptor 2\u2013negative metastatic breast cancer: ASCO guideline rapid recommendation update. J Clin Oncol 41:3423\u20133425. https:\/\/doi.org\/10.1200\/jco.23.00638","journal-title":"J Clin Oncol"},{"key":"8060_CR21","unstructured":"Food US, Administration D (2025) FDA approves imlunestrant for ER-positive, HER2-negative, ESR1-mutated advanced or metastatic breast cancer | FDA. https:\/\/www.fda.gov\/drugs\/resources-information-approved-drugs\/fda-approves-imlunestrant-er-positive-her2-negative-esr1-mutated-advanced-or-metastatic-breast. Accessed 30 Jan 2026"},{"key":"8060_CR22","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1200\/jco.2023.41.16_suppl.1066","volume":"41","author":"M Oliveira","year":"2023","unstructured":"Oliveira M, Pominchuk D, Hamilton EP et al (2023) Clinical activity of camizestrant, a next-generation SERD, versus fulvestrant in patients with a detectable ESR1 mutation: Exploratory analysis of the SERENA-2 phase 2 trial. J Clin Oncol 41:1066\u20131066. https:\/\/doi.org\/10.1200\/jco.2023.41.16_suppl.1066","journal-title":"J Clin Oncol"},{"key":"8060_CR23","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1016\/s1470-2045(22)00555-1","volume":"23","author":"F-C Bidard","year":"2022","unstructured":"Bidard F-C, Hardy-Bessard A-C, Dalenc F et al (2022) Switch to fulvestrant and palbociclib versus no switch in advanced breast cancer with rising ESR1 mutation during aromatase inhibitor and palbociclib therapy (PADA-1): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 23:1367\u20131377. https:\/\/doi.org\/10.1016\/s1470-2045(22)00555-1","journal-title":"Lancet Oncol"},{"key":"8060_CR24","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2502929","author":"F-C Bidard","year":"2025","unstructured":"Bidard F-C, Mayer EL, Park YH et al (2025) First-line camizestrant for emerging ESR1-mutated advanced breast cancer. N Engl J Med. https:\/\/doi.org\/10.1056\/nejmoa2502929","journal-title":"N Engl J Med"},{"key":"8060_CR25","unstructured":"Flatiron Health Database characterization guide https:\/\/flatiron.com\/database-characterization. Accessed 20 Mar 2025"},{"key":"8060_CR26","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1001\/jama.2019.3241","volume":"321","author":"G Singal","year":"2019","unstructured":"Singal G, Miller PG, Agarwala V et al (2019) Association of patient characteristics and tumor genomics with clinical outcomes among patients with non-small cell lung cancer using a clinicogenomic database. JAMA 321:1391\u20131399. https:\/\/doi.org\/10.1001\/jama.2019.3241","journal-title":"JAMA"},{"key":"8060_CR27","doi-asserted-by":"publisher","first-page":"e0237802","DOI":"10.1371\/journal.pone.0237802","volume":"15","author":"R Woodhouse","year":"2020","unstructured":"Woodhouse R, Li M, Hughes J et al (2020) Clinical and analytical validation of FoundationOne Liquid CDx, a novel 324-Gene cfDNA-based comprehensive genomic profiling assay for cancers of solid tumor origin. PLoS ONE 15:e0237802. https:\/\/doi.org\/10.1371\/journal.pone.0237802","journal-title":"PLoS ONE"},{"key":"8060_CR28","unstructured":"R The R project for statistical computing. . Accessed 20 May 2025 https:\/\/www.r-project.org\/"},{"key":"8060_CR29","doi-asserted-by":"publisher","unstructured":"Mayer EL, Bidard F-C, Park YH et al (2025) Patient-reported outcomes in the SERENA-6 trial of camizestrant plus CDK4\/6 inhibitor in patients with advanced breast cancer and emergent ESR1 mutations during first-line endocrine-based therapy. Ann Oncol https:\/\/doi.org\/10.1016\/j.annonc.2025.10.006","DOI":"10.1016\/j.annonc.2025.10.006"},{"key":"8060_CR30","doi-asserted-by":"publisher","first-page":"LBA1007","DOI":"10.1200\/jco.2026.44.17_suppl.lba1007","volume":"44","author":"FC Bidard","year":"2026","unstructured":"Bidard FC, Mayer EL, Park YH et al (2026) First-line (1L) camizestrant (CAMI) for emergent ESR1 mutations (ESR1m) in advanced breast cancer (ABC): Final progression-free survival 2 (PFS2) from the phase III SERENA-6 trial. J Clin Oncol 44:LBA1007. https:\/\/doi.org\/10.1200\/jco.2026.44.17_suppl.lba1007","journal-title":"J Clin Oncol"},{"key":"8060_CR31","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1200\/jco.2023.41.16_suppl.1062","volume":"41","author":"R Jeselsohn","year":"2023","unstructured":"Jeselsohn R, Chen L, Chaudhary N et al (2023) Endocrine therapy resistance (ETR) in hormone receptor-positive, HER2-negative metastatic breast cancer (HR+, HER2\u2013 mBC): Prevalence, biomarker characteristics, and outcomes. J Clin Oncol 41:1062\u20131062. https:\/\/doi.org\/10.1200\/jco.2023.41.16_suppl.1062","journal-title":"J Clin Oncol"},{"key":"8060_CR32","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1038\/s41523-026-00967-4","volume":"12","author":"F-C Bidard","year":"2026","unstructured":"Bidard F-C, Barrios C, Bianchini G et al (2026) SERENA-6 interpretation and clinical implications: intercepting endocrine resistance in metastatic breast cancer. NPJ Breast Cancer 12:80. https:\/\/doi.org\/10.1038\/s41523-026-00967-4","journal-title":"NPJ Breast Cancer"},{"key":"8060_CR33","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s13058-021-01462-3","volume":"23","author":"JO Brett","year":"2021","unstructured":"Brett JO, Spring LM, Bardia A, Wander SA (2021) ESR1 mutation as an emerging clinical biomarker in metastatic hormone receptor-positive breast cancer. Breast Cancer Res 23:85. https:\/\/doi.org\/10.1186\/s13058-021-01462-3","journal-title":"Breast Cancer Res"},{"key":"8060_CR34","doi-asserted-by":"publisher","first-page":"104556","DOI":"10.1016\/j.esmoop.2025.104556","volume":"10","author":"L Cabel","year":"2025","unstructured":"Cabel L, Bachelot T, Hardy-Bessard A-C et al (2025) Kinetics and determinants of blood ESR1 mutation under AI and palbociclib in HR+\/HER2- metastatic breast cancer patients in the PADA-1 trial. ESMO Open 10:104556. https:\/\/doi.org\/10.1016\/j.esmoop.2025.104556","journal-title":"ESMO Open"},{"key":"8060_CR35","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1038\/s41523-026-00894-4","volume":"12","author":"E Taranto","year":"2026","unstructured":"Taranto E, DeMichele A (2026) Evaluating the clinical utility of ctDNA testing to identify molecular cancer progression \u2013 lessons from SERENA-6. NPJ Breast Cancer 12:18. https:\/\/doi.org\/10.1038\/s41523-026-00894-4","journal-title":"NPJ Breast Cancer"},{"key":"8060_CR36","doi-asserted-by":"publisher","unstructured":"Bhave MA, Quintanilha JCF, Tukachinsky H et al (2024) Comprehensive genomic profiling of ESR1, PIK3CA, AKT1, and PTEN in HR(+)HER2(\u2013) metastatic breast cancer: prevalence along treatment course and predictive value for endocrine therapy resistance in real-world practice. Breast Cancer Res Treat 1\u201311. https:\/\/doi.org\/10.1007\/s10549-024-07376-w","DOI":"10.1007\/s10549-024-07376-w"},{"key":"8060_CR37","doi-asserted-by":"publisher","first-page":"2831","DOI":"10.1007\/s12325-022-02091-8","volume":"39","author":"AZ Torres","year":"2022","unstructured":"Torres AZ, Nussbaum NC, Parrinello CM et al (2022) Analysis of a real-world progression variable and related endpoints for patients with five different cancer types. Adv Ther 39:2831\u20132849. https:\/\/doi.org\/10.1007\/s12325-022-02091-8","journal-title":"Adv Ther"}],"container-title":["Breast Cancer Research and Treatment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10549-026-08060-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10549-026-08060-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10549-026-08060-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:54:36Z","timestamp":1790312076000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10549-026-08060-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["8060"],"URL":"https:\/\/doi.org\/10.1007\/s10549-026-08060-x","relation":{},"ISSN":["0167-6806","1573-7217"],"issn-type":[{"value":"0167-6806","type":"print"},{"value":"1573-7217","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"10 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Human ethics and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"ASCO Quality Care Symposium 2025.","order":2,"name":"Ethics","label":"Prior disclosures of these data","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Note: All authors are responsible for ensuring their own contact information, COIs, and contributions are accurate in the tables below. Disclose all relationships\/activities\/interests (within 36 months prior to submission) that are related to the content of your manuscript. \u201cRelated\u201d means any relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the manuscript. If you are in doubt about whether to list a relationship\/activity\/interest, it is preferable that you do so.","order":3,"name":"Ethics","label":"Author contacts, conflict of interest disclosures, and contributions","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"James Roose: Employment at Flatiron Health, Inc., which is an independent member of the Roche Group, and stock ownership in Roche. Ayush Kris: Employment at Flatiron Health, Inc., which is an independent member of the Roche Group. Timothy Pham: employment at AstraZeneca at the time of this study. Clara Chen: employment at AstraZeneca. Jane Meisel: Served in a consulting or advisory role for Novartis, AstraZeneca, Genentech, SeaGen, Olema Oncology, GE Healthcare, Pfizer, Stemline Therapeutics, and Sermonix Pharmaceuticals, and received institutional research funding from Pfizer, Seagen, Sermonix Pharmaceuticals, Olema Oncology, and AstraZeneca.","order":4,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Jane L. Meisel has served in a consulting or advisory role for Novartis, AstraZeneca, Genentech, SeaGen, Olema Oncology, GE Healthcare, Pfizer, Stemline Therapeutics, and Sermonix Pharmaceuticals, and received institutional research funding from Pfizer, Seagen, Sermonix Pharmaceuticals, Olema Oncology, and AstraZeneca. James Roose has employment at Flatiron Health, Inc., which is an independent member of the Roche Group, and stock ownership in Roche. Ayush Kris has employment at Flatiron Health, Inc., which is an independent member of the Roche Group. Clara Chen: employment at AstraZeneca. Timothy Pham: employment at AstraZeneca at the time of this study.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"8"}}