Medical Oncologist
Deciding on chemotherapy
Who is eligible for a genomic recurrence test?
These tests are for early breast cancer that is hormone receptor positive and HER2 negative, where the lymph nodes are clear or only slightly involved, and where your oncologist is genuinely undecided about chemotherapy. All three conditions have to hold. This page explains who qualifies, who the test cannot help, and how to raise it 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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The short answer
Who is a genomic recurrence test actually for?
These tests are for women with early breast cancer that is hormone receptor positive and HER2 negative, where the lymph nodes are clear or only slightly involved, and where the oncologist is genuinely undecided about chemotherapy.
All three conditions have to hold
The subtype has to be right, the disease has to be early, and the decision has to be open. If any one of those is missing, the test either does not apply or will not change anything. That is why not everyone is offered one.
The decision being open is the part people miss
A test only earns its cost if the result could move the recommendation. Where chemotherapy is clearly needed, or clearly not needed, the score is interesting but useless. Ask your oncologist whether they are undecided before you ask for the test.
Being told you do not need the test is usually good news. It generally means the answer is already clear.The conditions
The words used to describe who qualifies
- Hormone receptor positive
- Your tumour carries the oestrogen receptor, the progesterone receptor, or both. This is the group hormone tablets work in.
- HER2 negative
- Your tumour does not carry a large amount of the HER2 protein. HER2 positive cancers are treated on a different pathway where this test has no role.
- Node negative
- No cancer was found in the lymph nodes examined. This is where the test is best established.
- Limited node involvement
- One to three nodes involved. The test can be used here too, and the result is read more cautiously.
- Early breast cancer
- Cancer confined to the breast and nearby nodes. These tests have no role once cancer has spread to other organs.
- Premenopausal
- You have not yet gone through menopause. This changes how the score is interpreted rather than whether you qualify.
Who it does not suit
When the test will not help you
Saying this plainly matters, because these tests are sometimes offered to people they cannot help.
HER2 positive cancer
Treatment here is built around HER2-directed drugs given with chemotherapy. The question this test answers does not arise, so the result would change nothing.
Triple negative cancer
With no hormone receptors, there are no hormone tablets for chemotherapy to be compared against. Chemotherapy is the main treatment and the test has no role.
Check your own receptor results before agreeing.Cancer that has spread
These tests were built to guide treatment after surgery in early disease. Once cancer has reached other organs, treatment is chosen on an entirely different basis.
When the answer is already clear
A large, high grade cancer with several involved nodes, or a very small low grade one with clear nodes. In both, your oncologist already knows what to recommend.
Ask first
- Are you undecided about chemotherapy
- Would a low result change your advice
- Is my subtype right for this test
Not sure whether this applies to you?
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Side by side
Two situations, two answers
The test is likely to help
The test is unlikely to help
Hormone positive, HER2 negative
HER2 positive, or triple negative
Nodes clear, or one to three involved
Many nodes involved, or disease beyond the breast
Your oncologist says the decision is borderline
Your oncologist is already confident either way
Surgery is done and pathology is complete
Chemotherapy has already started
You would genuinely act on a low score
You have already decided what you want to do
Being straight with you
How to raise it with your oncologist
Asking about a test is not questioning your doctor's competence, and no reasonable oncologist treats it that way. The useful version of the conversation is specific rather than general.
Ask the decision question, not the test question
Instead of asking whether you can have the test, ask how confident they are about the chemotherapy recommendation and what would change their mind. If the answer reveals genuine uncertainty, the test follows naturally from that.
Ask for the benefit in plain numbers
Ask what chemotherapy would add for you in percentage points, not as a relative improvement. A treatment that reduces risk by a third sounds large and can mean a very small change when the starting risk is already low. The plain figure is what you should be deciding on.
Take someone with you
This conversation involves numbers, and numbers are hard to hold on to when you are frightened. Take the family member who will be part of the decision, and write the figures down in the room rather than trying to recall them afterwards.
What this page cannot tell you
It cannot tell you whether you qualify. That needs your receptor results, your HER2 status, your node result and your oncologist's honest view of how open the decision is. Take your pathology report to the appointment and work through those four things together.
Commonly believed
What people assume about eligibility
I was not offered the test, so I am being given second-rate care.
More often it means your subtype is wrong for it or the decision is already clear. Both are legitimate reasons. Ask which one applies to you, and you will usually get a straightforward and reassuring answer.
Paying for the test means better treatment.
It means better information for one specific decision, and only if you are in the group it was made for. Paying for a test outside that group buys a number nobody will act on.
If I ask for it, my doctor will be offended.
Competent oncologists expect these questions and many welcome them. If asking a reasonable question about your own treatment causes offence, that tells you something useful about where you are being treated.
The test can be done at any point.
It is most useful after surgery and before chemotherapy starts. Once treatment has begun the decision it informs has already been taken. If you want it, raise it in that window rather than later.
Questions we are asked
Common questions about eligibility
Can I have the test if one node was positive?
Often yes. The test can be used where one to three nodes are involved in hormone sensitive, HER2 negative cancer, and the result is read more cautiously than in node-negative disease. Ask your oncologist whether it would change their advice.
I am HER2 positive. Is there a similar test for me?
Not for this question. In HER2 positive disease the treatment is built around HER2-directed drugs given alongside chemotherapy, so there is no comparable decision for a genomic score to inform. Your plan follows a different pathway.
Does my age affect whether I can have it?
Age does not usually rule you out, but it changes how the result is read. In women who have not reached menopause, the same score has been interpreted more cautiously. Ask how your age affected the interpretation of your own result.
My tumour was very small. Do I still need it?
Often not. In a small, low grade, hormone sensitive cancer with clear nodes, chemotherapy is usually not recommended anyway, so the score would not change anything. Being told this is good news rather than a refusal.
Can I ask for it if my oncologist has not suggested it?
Yes, and the useful way to ask is by asking how confident they are about the chemotherapy decision. If they are certain, the test adds nothing. If they are weighing it up, the conversation about testing follows naturally.
Is it useful for lobular cancer?
It is used in lobular cancers, which are usually hormone sensitive and HER2 negative. Some oncologists read the result alongside the known behaviour of lobular disease rather than on its own. Ask how yours will be interpreted.
Do I need the test if I have already decided to have chemotherapy?
If you are certain, probably not. But it is worth asking what your absolute benefit would be before committing, because many people find the honest figure smaller than they expected, and some change their mind on seeing it.
Can it be done on a biopsy sample instead of surgery tissue?
Usually the surgical specimen is preferred because there is more tissue and it represents the whole tumour. Where chemotherapy is being given before surgery, the biopsy block may be used instead. Your oncologist will know which applies.
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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.