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Genomic testing in breast cancer

Oncotype, MammaPrint and — Genomic Recurrence Scores

These are tests done on breast tumour tissue — not on your blood — that look at the activity of specific genes. They predict how likely an early-stage breast cancer is to return, and whether chemotherapy is likely to add meaningful benefit.

Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed September 2026

  • Done on stored tumour tissue — No new biopsy is usually needed. The test is run on the block of tissue from your original biopsy or surgery.
  • Predicts recurrence risk — The score estimates how likely the cancer is to return — not whether it will definitely come back or definitively not.
  • Available in India, but expensive — Samples are sent to accredited overseas laboratories. The cost is significant and insurance coverage varies widely.
  • One input among several — The result informs your oncologist's recommendation — it does not make the treatment decision on its own.
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Oncotype DX and MammaPrint are genomic tests done on breast tumour tissue. They predict how likely early breast cancer is to return and whether chemotherapy is likely to add meaningful benefit. In India, these tests are available but expensive, and results guide — they do not replace — your oncologist's treatment decision.

What do these tests actually predict?

Genomic recurrence scores measure the activity level of specific genes inside your tumour. A cancer with certain gene patterns is more likely to return than one with different patterns, even when both look similar under a microscope.

These tests are validated for hormone-receptor-positive, HER2-negative early breast cancer — the most common breast cancer type in India. They are not used for HER2-positive cancer, triple-negative cancer, or cancer that has already spread to distant organs.

A low score suggests the cancer is unlikely to return and chemotherapy is unlikely to add meaningful benefit beyond hormone therapy. A high score suggests the reverse. An intermediate score means the answer is less certain, and your oncologist weighs it against other clinical factors — including your age and menopausal status.

What is the difference between Oncotype DX and MammaPrint?

FeatureOncotype DXMammaPrintProsigna (PAM50)
Genes analysed21 genes70 genes50 genes
Result formatScore 0–100Low risk or High riskRisk category plus score
Who it is used forHR+, HER2−, early breast cancer; node-negative or limited node involvementHR+, HER2−, early breast cancer; up to 3 positive nodesHR+, HER2−, early breast cancer; post-menopausal
Sample neededStored tissue block (FFPE)Stored tissue block (FFPE)Stored tissue block (FFPE)
Where processedUSA (accredited laboratory)Netherlands or USAUSA (accredited laboratory)
Key supporting trialTAILORx, RxPONDERMINDACTABCSG-8 and others
Availability in IndiaAvailable via referral labsAvailable via referral labsLimited

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When is a genomic recurrence score most likely to apply to you?

  • Your breast cancer is hormone-receptor-positive (ER+ or PR+) and HER2-negative.
  • The cancer is early stage — it has not spread to distant organs.
  • Your oncologist is weighing whether chemotherapy would add meaningful benefit for you.
  • Hormone therapy alone may be a realistic option and clinical factors alone do not settle the question.
  • Your tumour tissue from surgery or biopsy is available in a stored tissue block.
  • You want an additional data point to inform the treatment discussion with your oncologist.

What do the terms on these reports mean?

Recurrence Score
A number — on a scale of 0 to 100 for Oncotype DX — representing the estimated risk of the cancer returning based on gene activity in your tumour. Lower numbers indicate lower predicted risk.
Low risk
The gene activity pattern suggests a lower likelihood of the cancer returning. ASCO and NCCN guidance indicates that chemotherapy is unlikely to add meaningful benefit in this group.
High risk
The gene pattern suggests a higher likelihood of recurrence. Evidence supports that chemotherapy alongside hormone therapy is more likely to add meaningful benefit in this group.
Intermediate risk
The score falls in a middle range where the prediction is less certain. Your age, menopausal status and lymph node involvement weigh heavily in the final recommendation.
HR+ (hormone-receptor positive)
Cancer cells carry receptors for oestrogen or progesterone. Genomic recurrence scores are validated specifically for this tumour type.
HER2− (HER2-negative)
Cancer cells do not carry excess copies of the HER2 gene. Genomic scores are validated for this group and are not used in HER2-positive cancers.
FFPE tissue block
Formalin-fixed paraffin-embedded tissue — the standard way tumour samples are stored after biopsy or surgery. This is what the laboratory receives; a new biopsy is usually not needed.
Gene expression
How actively a gene is working — whether it is producing a lot of its protein or very little. Genomic tests measure this activity across multiple genes simultaneously.

Did you know?

In the TAILORx trial, a significant proportion of patients with early-stage, hormone-receptor-positive breast cancer who received a low Oncotype DX recurrence score did as well on hormone therapy alone as those who also received chemotherapy.

For those patients, the test provided evidence to avoid chemotherapy — and its side effects — rather than evidence to add it.

Source: TAILORx Trial (NEJM 2018), cited in ASCO and NCCN Breast Cancer Guidelines

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Common questions

Frequently asked questions

How much does Oncotype DX cost in India?

The cost is significant — enough to represent a meaningful expense for most families — and it varies between referring laboratories and changes over time. Confirm the current figure with your oncologist or the laboratory before deciding. Insurance coverage for genomic tests is inconsistent and many policies do not include them. Some families find the cost easier to weigh when they understand that a low result may mean avoiding chemotherapy entirely, which carries its own financial and physical costs.

Do I need a new biopsy to do Oncotype DX?

Usually not. The test uses stored tumour tissue from your original biopsy or surgery — a block that pathology laboratories routinely preserve. Your oncologist will request that block from the hospital where your procedure was done. Occasionally the original sample is too small or degraded for the test, and a new procedure may be needed, but this is uncommon.

Is a high recurrence score a death sentence?

No. A high score means the gene activity pattern is associated with a higher likelihood of the cancer returning, and that chemotherapy alongside hormone therapy is more likely to add benefit. It is a probability estimate — not a certainty about what will happen to you. Many people with high scores who receive appropriate treatment do not experience a recurrence. The score is one input your oncologist uses to build a treatment plan. It does not define your outcome.

Is MammaPrint or Oncotype DX better?

Both are validated by large clinical trial data and are referenced in ASCO and NCCN guidelines. They measure different genes and report results differently, but their purpose is similar. Which is more appropriate depends on your clinical picture — your age, menopausal status, lymph node involvement, and what your oncologist is trying to establish. Ask which test is being recommended and why, given your specific case.

Can I get this test at a government hospital in India?

Most government hospitals in India do not currently offer genomic recurrence score testing, because samples must be sent to accredited overseas laboratories and the cost is substantial. Some larger academic cancer centres have referral arrangements. ICMR is engaged in research to expand access, but coverage through public health programmes is not yet established. Your oncologist is best placed to advise on what is accessible where you are.

My oncologist has not mentioned this test. Should I ask?

It is entirely reasonable to raise the question. The test is most relevant when you have early-stage, hormone-receptor-positive, HER2-negative breast cancer and the decision about adding chemotherapy to hormone therapy is not clear-cut on clinical factors alone. If that describes your situation and the topic has not come up, ask your oncologist whether a genomic recurrence score would add useful information to your treatment discussion. They may have already considered and ruled it out for a specific reason — or it may be a helpful conversation to have.

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