Medical Oncologist
Deciding on chemotherapy
MammaPrint, Prosigna and EndoPredict: the other genomic tests
MammaPrint, Prosigna and EndoPredict answer broadly the same question as Oncotype DX: how much chemotherapy is likely to add on top of hormone tablets. They read different genes and report the answer differently, and they are not interchangeable. This page sets out how they differ and what actually matters when one is chosen for you.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What are the other genomic tests, and how do they differ?
MammaPrint, Prosigna and EndoPredict answer broadly the same question as Oncotype DX: how much chemotherapy is likely to add on top of hormone tablets. They read different sets of genes and report the answer in different formats, and they are not interchangeable.
Why more than one test exists
Each was developed by a different group, validated in different studies and cleared in different countries. None of them is simply a cheaper copy of another. They were built to answer the same clinical question by different routes.
Which one you are offered depends on your hospital
Availability, price and your oncologist's familiarity all come into it. This is a reasonable basis for choosing, provided the test is validated for your situation. What matters most is that your oncologist will act on the result.
All of these apply to hormone sensitive, HER2 negative early breast cancer. None has a role in other subtypes.The vocabulary
What each test reports
- MammaPrint
- Reads a large panel of genes and reports a simple two-way answer: low risk or high risk. There is no middle band, which some oncologists value and others find too blunt.
- Prosigna
- Reports a risk score and also names the intrinsic subtype of your cancer. It can often be run in a local laboratory rather than shipped abroad.
- EndoPredict
- Combines a gene reading with your tumour size and node status into a single score, and is designed to speak to the risk of late recurrence as well as early.
- Intrinsic subtype
- A biological grouping of breast cancers based on gene activity rather than appearance under the microscope.
- Late recurrence
- Cancer returning many years after treatment. It is a particular concern in hormone sensitive disease.
- Validated
- Tested in a properly designed study and shown to predict what it claims to. This is the word to ask about.
What sets them apart
The practical differences between them
The differences that affect you are about format, timing and where the test is run.
Two answers or three
A two-way result removes the uncomfortable middle band, which makes the decision cleaner. It also removes the nuance some women want when they are weighing a borderline choice.
Where the sample goes
Some tests are run locally and some are shipped abroad. A local test usually returns faster and avoids customs delays, which matters when you are waiting to start treatment.
Ask where your sample will go and how long it takes.What they say about late risk
Some tests are designed to speak to the risk of recurrence many years later, which can inform how long you stay on hormone tablets. This is a different question from the chemotherapy one.
What your oncologist knows
A test your team uses regularly and interprets confidently is worth more than an unfamiliar one with a marginally better paper behind it.
Ask before choosing
- Which do you use most, and why
- Would you act on this result
- Where is it run and how long does it take
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Side by side
Where these tests agree and differ
The same across all of them
Different between them
They answer the chemotherapy question
How the answer is reported, as bands or as two groups
They apply to hormone positive, HER2 negative disease
Which genes are read, and how many
They are run on stored tumour tissue
Whether the sample is shipped abroad or run locally
They assume you will take hormone tablets
How well each speaks to risk many years later
They are rarely covered by insurance here
Price, turnaround time and local availability
Being straight with you
What none of these tests can do
None of them tells you whether your cancer will come back. They tell you how much one treatment is likely to add. Every one of them is a group estimate applied to an individual, and that limitation applies equally to all of them.
They can disagree with each other
Running two different tests on the same tumour can produce answers that point in different directions, because they read different genes. This is not a scandal, and it is not a reason to run a second test hoping for a more comfortable answer. Choose one, with your oncologist, and act on it.
Availability shapes the choice more than evidence does
In practice, most people are offered whichever test their hospital has a route for. That is an honest description of how the decision is made here, and it is a reasonable one provided the test is validated for your situation.
What to ask before agreeing
Ask which test is being proposed, whether it is validated for your node status and your age group, how long the result will take, what it costs all in, and whether your oncologist would genuinely act on a low result. Five questions, and they cover everything that matters.
Commonly believed
What people assume when comparing tests
The newest test must be the most accurate.
The strength of these tests comes from years of follow-up in large groups. A newer test has, by definition, less of that. Newness is not an advantage here, and in this field it is often the opposite.
I should run two tests to be sure.
They read different genes and can give different answers, so a second test usually buys confusion rather than confidence. Choose one with your oncologist, and agree beforehand that you will act on it.
A two-way answer means a cruder test.
It is a deliberate design choice. Removing the middle band makes the decision cleaner for many women. Whether you prefer that or prefer the nuance of three bands is a fair thing to raise with your oncologist.
These tests replace my oncologist's judgement.
They inform one decision. Your age, your grade, your nodes, your other health conditions and your own view all sit alongside the result. A test result read without the rest of the picture is worth very little.
A test done abroad must be more reliable.
What matters is that the laboratory is accredited and that your oncologist knows how to read the result against your own report. Sending a sample overseas adds weeks and cost, and the decision it informs is the same one either way. Ask what your centre uses and why.
Questions we are asked
Common questions about the other genomic tests
Which test is best?
There is no single answer, and reasonable oncologists choose differently. What matters is that the test is validated for your node status and age group, that it is available without a long delay, and that your oncologist will act on the result.
Can I choose which test I have?
Within what your hospital can arrange, yes. Ask which tests they have a route for, what each costs all in, and how long each takes. Then let your oncologist recommend one for your particular situation.
Are any of them run in India?
Some can be run in local laboratories and others are shipped abroad, and this changes over time. Ask your hospital directly where your sample would go, because it affects both the wait and the price.
What if two tests disagree?
It happens, because they read different genes. This is the main argument for choosing one test and committing to it. If you are already holding two conflicting results, ask your oncologist which one is better validated for your situation.
Do any of them tell me how long to stay on hormone tablets?
Some are designed to speak to the risk of recurrence many years later, which can inform that conversation. It is a different question from the chemotherapy one, so say clearly which question you want answered.
Is the intrinsic subtype useful to know?
It adds biological detail and some oncologists find it helpful in borderline cases. It rarely changes the recommendation on its own. Treat it as extra information rather than as a reason to choose one test over another.
Are they covered by insurance?
Rarely. Most policies and government schemes here treat genomic testing as an investigation and exclude it. Get your insurer's position in writing before the tissue is sent rather than claiming afterwards.
Can these tests be used if I have already had chemotherapy?
They lose most of their value once the decision they inform has been made. If you are considering stopping treatment part way, raise it immediately and ask what the test could realistically still change.
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Sources
- National Cancer Institute — Breast cancer gene expression tests
- Cancer Research UK — Tests to help decide on chemotherapy
- Breast Cancer Now — Tests to predict the benefit of chemotherapy
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.