Evandro de Azambuja, MD, PhD, L’Universite Libre de Bruxelles, Brussels, Belgium, explains why all patients with newly diagnosed metastatic breast cancer (BC) should not receive a next generation sequencing (NGS) multi-panel gene test. First-line treatment strategies for patients with the three main BC subtypes (hormone receptor (HR)-positive/HER2-negative; HER2-positive; triple negative) are well-defined and are highly efficacious. Dr de Azambuja argues that test results would probably not change recommended treatment strategies. Indeed, very few patients who complete the test will be eligible for a clinical trial or have a druggable target. Nevertheless, Dr de Azambuja encourages including those patients in clinical trials to understand the history, heterogeneity and behaviour of their tumors. This interview took place at the European Society for Medical Oncology (ESMO) 2021 congress.