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Why drug-gene testing is not routine in India yet | CION Cancer Clinics
Drug-gene tests are available in India, but most hospitals do not order them automatically. The research and gene panels were built on patients abroad, the family usually pays, and there is no national rule yet. Oncologists keep treatment safe by starting carefully and adjusting the dose. This page explains the gaps, what happens instead, and when it is worth asking. At CION Cancer Clinics, our team helps carriers and their families plan checks, next steps and support after a genetic result.
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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
- Why is drug-gene testing not routine in India yet?
- What is holding routine testing back?
- How do oncologists keep treatment safe without the test?
- The words doctors use about this, in plain language
- Testing first compared with watching and adjusting
- What this page cannot tell you
- Four things families tell us, and what is actually true
- Common questions about drug-gene testing in India
The short answer
Why is drug-gene testing not routine in India yet?
Mainly because the evidence, the gene panels and the guidelines were built on patients abroad, and India has not yet made the test a standard step. Cost, access to laboratories and the time a result takes all add to that. In the meantime, most Indian oncologists protect patients by starting carefully and adjusting the dose as treatment goes on.
What routine would actually mean
A routine test is one done for everyone before a given drug, without anyone needing to ask. Parts of Europe now do this before fluorouracil and capecitabine. In India the same test is available at several laboratories, but whether it is done depends on the hospital, the doctor and often on whether the family asks.
Why this is not a scandal
Severe reactions linked to these genes are uncommon, and there is a safe alternative way of working that Indian oncologists have used for decades. The honest position is that testing would prevent some harm, and that India is still working out how to offer it fairly and at a price families can manage.
Not being routine does not mean the test is unavailable. It means nobody will order it automatically.The real reasons
What is holding routine testing back?
None of these is a single decision anyone made. Each one is a gap that is slowly being closed.
The evidence was built elsewhere
Most of the research linking gene versions to drug reactions was done in European and American patients. The gene versions checked on standard panels are the ones common there. Some of them are rare in Indian families, and versions more common here may be missed.
The cost falls on the family
The test is usually paid for out of pocket. Whether an insurer or a public scheme such as Aarogyasri or Ayushman Bharat will cover it varies, and many families already stretched by treatment costs decline an extra test.
Laboratories are concentrated in cities
Few laboratories run these tests, and most are in metro cities. Samples from district hospitals often travel before they are read. The wait for a result can feel long when a patient is ready to start.
This affects
- Patients treated outside large cities
- Anyone needing treatment to start urgently
No national rule yet
India does not yet have a national guideline that makes drug-gene testing a standard step before these drugs. Without one, practice depends on each hospital's own policy and each doctor's habit.
Not sure whether this applies to you?
Ask an oncologistWhat happens instead
How do oncologists keep treatment safe without the test?
The dose is worked out from your size
Most chemotherapy doses are calculated from height and weight, then adjusted for age, kidney and liver function, and your general health.
Blood tests come before each cycle
Blood counts and kidney and liver tests are checked before every cycle. A sharp fall in counts is often the first sign that a drug is building up.
You are asked about side effects
Diarrhoea, mouth sores, fever and extreme tiredness are all asked about at each visit. You are told which ones to report straight away between visits.
The dose is lowered or paused if needed
If side effects are severe, the next dose is reduced or delayed. For most people this works well. Its weakness is that it reacts to harm rather than preventing it, which matters most for the rare person with a missing enzyme.
Terms you may hear
The words doctors use about this, in plain language
- Routine testing
- A test done for every patient before a given drug, as a standard step that nobody has to ask for.
- Pre-emptive testing
- Testing before the drug is ever given, so the first dose is already adjusted.
- Reactive testing
- Testing after a severe reaction, to find out whether a gene was the cause and to guide what happens next.
- Gene panel
- A fixed list of gene versions a laboratory checks. A version not on the list will not be reported, even if you carry it.
- Turnaround time
- How long the laboratory takes to return a result after it receives the sample.
- Cost-effectiveness
- Whether the harm a test prevents is worth what it costs across everyone tested. Health systems use this to decide what becomes routine.
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Side by side
Testing first compared with watching and adjusting
Test before the first dose
Watch and adjust
Finds a slow enzyme before any harm
Finds a problem once side effects appear
Needs a laboratory and a short wait
Needs no extra test
Adds a cost the family often pays
Uses blood tests already being done
Protects the rare person with a missing enzyme
Works well for most, less well for that rare person
Being straight with you
What this page cannot tell you
It cannot tell you whether you should have the test. That depends on which drugs are planned, how soon treatment must start, and what your oncologist has seen in patients like you. It is a fair question to put to them before the first cycle, and a good doctor will explain their reasoning either way.
It cannot say how things will change
Indian genome projects are now mapping gene versions across many communities, and testing costs are falling. That may change what becomes routine here. When and how is not yet known, and we will not guess.
Who this does not apply to
Most people having cancer treatment in India do not need to worry about this. The majority of cancer drugs have no gene test attached, and surgery and radiotherapy have none. If none of fluorouracil, capecitabine, irinotecan or the thiopurine tablets is in your plan, this page is background reading only. If your result is in your hand, what it means for your dose is a question for the doctor who ordered it.
Studies of these genes in Indian patients so far are small. Anyone who claims certainty about Indian figures is ahead of the evidence.Commonly believed
Four things families tell us, and what is actually true
"If it is not routine, Indian hospitals must be behind."
Many countries outside Europe do not test routinely either. The watch-and-adjust approach is a recognised way of working. The real debate is about how best to protect the rare person at risk.
"A test done abroad or online will give a complete answer."
Every laboratory checks a fixed list of gene versions. A panel designed for European patients can miss versions more common in Indian families. A negative result lowers the risk. It does not remove it.
"Without the test, chemotherapy is dangerous."
For most people it is given safely without one, with close blood tests and dose changes. Severe gene-linked reactions are uncommon. The test adds a layer of protection. It is not the only one.
"The doctor did not mention it, so it must not exist."
Because it is not routine, many doctors will not raise it unless asked. You are allowed to ask, and the question will not offend a good oncologist.
Questions we are asked
Common questions about drug-gene testing in India
Is drug-gene testing available in India at all?
Yes. Several laboratories in India offer tests for DPYD, TPMT, NUDT15, UGT1A1 and G6PD, and some offer wider panels. What is missing is a standard rule that it is done for every patient. Your oncologist can tell you which laboratory they trust and how long it takes.
Is it covered by Aarogyasri or Ayushman Bharat?
Coverage varies, so check before assuming. Public schemes and private insurers generally cover defined treatment packages, and an extra pre-treatment test may or may not fall inside them. The hospital's insurance desk can check your specific scheme.
Why do European hospitals test when Indian ones often do not?
European regulators reviewed the evidence and recommended testing before certain drugs. Their health systems pay for it, and their gene panels were built on their own populations. India has not yet made the same decision, partly because the Indian evidence is still being gathered.
Will waiting for the test delay my treatment?
It can add a short wait, depending on where the sample is sent. If treatment is urgent, some doctors start at a cautious dose and adjust once the result arrives. Ask your oncologist how they would handle the timing in your situation.
If I had a severe reaction, should I be tested now?
It is often worth asking. A test after a reaction can show whether a gene was involved and can guide the next dose or the choice of another drug. The result also stays useful for any future treatment you need.
Are Indian gene versions different from European ones?
Some are. Gene versions vary between populations, and India itself contains many communities with different patterns. That is why a panel built for one population may miss versions common in another, and why Indian research in this area matters so much.
Can my family doctor order the test?
They can, but the result is only useful to the oncologist deciding your doses. It works best when ordered by the treating team, who know which genes to check for the drugs planned and how to act on the answer.
Will this become routine in India soon?
Nobody can say when. Falling costs and Indian genome research are both moving things forward, and some hospitals already test more often than others. For now, the practical step is to ask your oncologist whether a test would change anything in your own treatment plan.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Sources
- MedlinePlus Genetics — What is pharmacogenomics?
- Clinical Pharmacogenetics Implementation Consortium (CPIC) — CPIC Guidelines
- US Food and Drug Administration — Table of Pharmacogenomic Biomarkers in Drug Labeling
- Cancer Research UK — Capecitabine (Xeloda)
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.
Keep reading
Related pages
Is pharmacogenomic testing available in Hyderabad?Where the test can be done locallyCost of drug-gene testingWhat families usually pay, and what changes itAsking for a drug-gene test before treatment startsHow to raise it with your oncologistWhy NUDT15 matters especially in South AsiaOne gene where Indian ancestry really matters
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