Medical Oncologist
Deciding on chemotherapy
Was a genomic test skipped in your treatment plan?
Possibly, but usually the answer is no and for a good reason. These tests only help when your cancer is hormone receptor positive and HER2 negative, the disease is early, and the chemotherapy decision is genuinely open. This page shows you the four lines on your own report that decide it, and how to raise the question properly.
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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On this page
- Should I have been offered a genomic test?
- The four lines that decide whether it applies
- Asking without turning it into a confrontation
- Good reasons it was not offered, and reasons worth questioning
- What to do if you have already started treatment
- What families conclude when they read about these tests
- Common questions about a test you were not offered
The short answer
Should I have been offered a genomic test?
Possibly, but in most cases the answer is no, and for a good reason. These tests only help when your cancer is hormone receptor positive and HER2 negative, the disease is early, and your oncologist is genuinely undecided about chemotherapy. If any of those is missing, the test changes nothing.
Why you may not have been told about it
Oncologists do not routinely list every test that does not apply. If your cancer is triple negative or HER2 positive, a genomic recurrence test was never on the table, so it would not have been mentioned. The same is true when the chemotherapy decision was already clear.
When it is worth raising
Raise it if your cancer is hormone sensitive and HER2 negative, your nodes were clear or only slightly involved, and you have been advised to have chemotherapy without a clear explanation of how much it will add. That is exactly the situation these tests were built for.
You can raise this after starting treatment, but it is far more useful before the first cycle.Check your own report
The four lines that decide whether it applies
- ER and PR
- If either is positive, you clear the first condition. If both are negative, these tests have no role for you.
- HER2
- Must be negative. A HER2 positive cancer is treated on a different pathway where this question does not arise.
- Lymph nodes
- Clear, or one to three involved. With many nodes involved the decision is usually already settled.
- Stage
- Early breast cancer, meaning confined to the breast and nearby nodes. These tests have no role once cancer has spread further.
- Grade and size
- Not conditions in themselves, but a very small low grade cancer or a large high grade one usually means the answer is already known.
How to raise it
Asking without turning it into a confrontation
The aim is a real answer, not a concession. Framing the question well is what gets you one.
Ask about the decision, not the test
Start with how confident they are about the chemotherapy recommendation. If there is genuine uncertainty, the conversation about testing follows naturally from that.
Ask for the benefit in plain numbers
How many percentage points would chemotherapy add for me? If the answer is a large figure, the test is unnecessary. If it is small, the test becomes worth discussing.
Write the number down in the room.Ask whether your subtype qualifies
A one-line answer that usually settles it. If you are HER2 positive or triple negative, you have your explanation and you can stop worrying about a missed option.
Ask what would change their mind
This is the most revealing question in any medical conversation. If nothing would, the test cannot help you. If a low score would, you now know exactly what you are asking for.
Four questions
- How confident are you
- How much would chemotherapy add
- Does my subtype qualify
- What would change your mind
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Side by side
Good reasons it was not offered, and reasons worth questioning
A sound reason not to test
A reason worth questioning
Your cancer is HER2 positive or triple negative
Nobody explained why chemotherapy is being advised
Chemotherapy is clearly needed on size, grade and nodes
You were given no benefit figure at all
Chemotherapy was clearly unnecessary anyway
You were told the test is simply not available
The result could not be returned in a safe timeframe
Cost was assumed on your behalf without asking you
Your disease has already spread beyond the breast
You are hormone positive, HER2 negative and node negative
Being straight with you
What to do if you have already started treatment
The test loses most of its value once chemotherapy has begun, because the decision it informs has already been taken. That is worth knowing before you spend weeks pursuing it.
If you are part way through
Raise it immediately rather than at the end. Ask what the test could realistically still change. In most cases the honest answer is very little, and hearing that clearly is better than carrying the question for years.
If treatment has finished
Testing now will not change what has already been given. What can still be discussed is the length of your hormone treatment and how closely you are followed up. Those are live questions and worth putting your energy into instead.
On looking backwards
Many families arrive at this question months later and start wondering whether the wrong thing was done. Treatment given for a hormone sensitive, node-positive cancer is rarely wrong, even where a test might have opened another route. Ask the question, get an honest answer, then let it go. The energy is better spent on the treatment you are taking now.
Commonly believed
What families conclude when they read about these tests
We were not offered it because we cannot afford a private hospital.
Far more often it is because the subtype is wrong or the decision was already clear. Ask which applies. If cost was assumed on your behalf without being discussed with you, that is a fair thing to raise directly.
Asking will make my oncologist defensive.
Competent oncologists field this question regularly and most welcome an engaged patient. If a reasonable question about your own treatment causes offence, that tells you something worth knowing about where you are being treated.
A test would have spared me chemotherapy.
It might have, or it might have confirmed the recommendation. Around half the people who have these tests are advised to have chemotherapy afterwards. Assuming the result would have gone your way is not a safe assumption.
Hospitals avoid the test to keep chemotherapy revenue.
In the great majority of cases the test simply does not apply. Where you have a real doubt about the reasoning, the answer is a second opinion with your full reports, not a theory about motives.
Questions we are asked
Common questions about a test you were not offered
How do I know if the test applied to me?
Look at four lines on your pathology report: ER, PR, HER2 and the node result. Hormone positive, HER2 negative, with clear or lightly involved nodes is the group. If you fall outside it, the test was never relevant to your case.
Can I ask for it now, after surgery?
Yes, and the window between surgery and the start of chemotherapy is exactly when it is most useful. Raise it at your post-surgery appointment rather than waiting for the chemotherapy planning visit.
Is it too late once chemotherapy has started?
Largely, yes, because the decision it informs has been made. If you are considering stopping part way through, raise it at once and ask specifically what the test could still change in your plan.
My hospital says they do not offer it. What now?
Ask whether they can arrange it through another centre, and ask what it would cost all in. If they cannot, a second opinion elsewhere with your blocks and slides is a reasonable next step while the decision is still open.
Should I delay chemotherapy to wait for a result?
A short wait is usually acceptable and your oncologist will say whether it is in your case. Do not delay on your own initiative without telling them, because the timing of treatment after surgery does matter.
Does the test exist for triple negative cancer?
Not for this question. With no hormone receptors there are no tablets for chemotherapy to be compared against. Chemotherapy is the main treatment, and the decision is about which drugs rather than whether to have them.
Will my oncologist mind if I get a second opinion?
A reasonable one will not, and many will help you arrange it. Ask for copies of your reports, and where possible the tissue blocks and slides, because a second opinion on the tissue is far more useful than one on a typed summary.
Is it worth paying for privately?
Only if your subtype qualifies and your oncologist would act on the result. Ask that one question before paying: if the score came back low, would you leave chemotherapy out? A no means the money is better kept.
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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 — Getting a second opinion
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.