Authors' objectives: We searched for evidence that could be used to answer the review question: What is the clinical and cost effectiveness of MAF-gene tests to guide adjuvant bisphosphonate treatment in early breast cancer?

Authors' results and conclusions: The clinical effectiveness of MAF gene testing has been studied in retrospective subgroup analyses of two randomised controlled trials. These trials were designed to evaluate the effectiveness of bisphosphonates, but did not evaluate the prospective use of MAF gene testing to guide treatment. The lack of evidence prospectively comparing MAF gene testing with menopausal status or age as patient stratification methods means the effectiveness of using the test to guide treatment is uncertain. Economic modelling estimated that using MAF gene testing to guide adjuvant bisphosphonate treatment could be cost effective compared with usual care. However, the uncertainties in the clinical effectiveness evidence also apply to the economic modelling.

Authors' recommendations: There is insufficient evidence to support the routine adoption of MAF gene testing to guide adjuvant bisphosphonate treatment in early breast cancer.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: Further research is recommended evaluating the use of MAF gene testing to guide bisphosphonate use in prospective studies and real-world clinical practice.

Project Status: Completed

Year Published: 2025

URL for published report: https://healthtechnology.wales/reports-guidance/maf-gene-tests-to-guide-adjuvant-bisphosphonate-treatment-of-breast-cancer/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk