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HRD testing: what it says about BRCA, and what it does not | CION Cancer Clinics
An HRD test checks whether a tumour has lost a DNA repair system that BRCA1 and BRCA2 help to run. It is used mainly in ovarian cancer, to help decide on a group of medicines called PARP inhibitors. A positive result can come from a BRCA fault, but it cannot show whether that fault was inherited. This page explains what HRD means, what causes it, and why a blood test is still needed. At CION Cancer Clinics in Hyderabad, our oncologists review your family history with you and guide you to the right genetic counselling and testing.
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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
- What does an HRD test say about BRCA?
- What can make a tumour HRD-positive?
- How does an HRD result connect to a germline test?
- The words on an HRD report, in plain language
- HRD test or germline BRCA test: what does each tell you?
- Four things families assume about HRD results
- What this page cannot tell you
- Common questions about HRD testing and BRCA
The short answer
What does an HRD test say about BRCA?
An HRD test checks whether a tumour has lost one of its DNA repair systems, the one that BRCA1 and BRCA2 help to run. A positive result may be caused by a BRCA fault, but it cannot tell you whether that fault was inherited. Only a germline test on blood answers the family question.
What HRD actually means
HRD stands for homologous recombination deficiency. Cells use this repair system to fix a serious kind of DNA damage, where both strands break. When it stops working, the tumour patches the breaks badly and leaves a pattern of scars in its DNA. HRD tests look for those scars, and usually for BRCA changes in the tumour as well.
Why oncologists order it
Tumours that cannot repair themselves this way are often more sensitive to a group of medicines called PARP inhibitors, and to some chemotherapy. HRD testing is used mostly in ovarian cancer, to help decide on these medicines after first treatment. The treatment side is explained on our targeted therapy pages.
An HRD result describes the tumour. It is not a verdict on your family.Behind a positive result
What can make a tumour HRD-positive?
Several different causes produce the same result. Only one of them is certain to matter for your relatives.
An inherited BRCA fault
The fault was present from birth in every cell. The tumour lost the remaining working copy. This is the cause that brothers, sisters and children could share.
A BRCA change in the tumour only
The change arose in the cancer during life. It can still make treatment work better, but it is not in the rest of your body and cannot be passed on.
Faults in other repair genes
Genes such as PALB2, RAD51C and RAD51D work in the same repair system. Faults in them can be inherited or tumour-only.
A germline test can check
- BRCA1 and BRCA2
- Other repair genes on a suitable panel
A gene switched off, not broken
Sometimes BRCA1 is silenced in the tumour by a chemical tag on the DNA, called methylation, without any spelling change. This is usually not inherited. Sometimes no cause is found at all.
Not sure whether this applies to you?
Ask an oncologistFrom tumour to family
How does an HRD result connect to a germline test?
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Tumour tissue is sent
Usually from the biopsy or surgery, stored in a wax block. The quality and amount of tissue matter for a reliable result.
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The lab looks for two things
It checks for BRCA changes in the tumour, and it measures the scar pattern left by failed repair. Together these give the HRD result.
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Your oncologist uses it for treatment
The result is one of the factors in deciding whether a PARP inhibitor is offered, and when.
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A germline test answers the family question
In ovarian cancer, a blood test is usually offered to everyone, whatever the HRD result. It shows whether any BRCA fault was inherited.
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Relatives are tested only if blood shows a fault
If the blood test finds an inherited fault, relatives can have a simple test for it. A tumour-only change does not lead to family testing.
On your report
The words on an HRD report, in plain language
- HRD positive or negative
- Whether the tumour appears to have lost its homologous recombination repair system.
- Genomic instability score
- A measure of how much scarring the tumour's DNA shows. The lab compares it with its own cut-off.
- Tumour BRCA status
- Whether a harmful BRCA change was found in the tumour. It does not say whether the change was inherited.
- Germline BRCA status
- Whether a harmful BRCA fault was found in blood, meaning it was present from birth.
- PARP inhibitor
- A targeted medicine that attacks cancer cells already weak at DNA repair.
- Methylation
- A chemical tag that can switch a gene off without changing its spelling.
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Side by side
HRD test or germline BRCA test: what does each tell you?
HRD tumour test
Germline BRCA test
Uses tumour tissue
Uses blood or saliva
Asks whether the tumour can repair itself
Asks whether a fault was inherited
Helps decide on PARP inhibitors
Guides treatment, screening and family testing
Says nothing certain about relatives
Tells relatives whether there is a fault to test for
Ordered by the oncologist
Ordered after genetic counselling
Commonly believed
Four things families assume about HRD results
"HRD-positive means I have an inherited BRCA fault."
It may, or it may not. The same result can come from a tumour-only change, another repair gene or a silenced gene. A blood test is the only way to know.
"HRD-negative means my family is not at risk."
It lowers the chance of an inherited BRCA fault but does not settle it. In ovarian cancer, germline testing is usually offered anyway, and the family history still counts.
"My blood BRCA test was negative, so the HRD test is pointless."
Not so. A tumour can be HRD-positive for reasons that never show in blood, and that can still open a treatment option.
"The HRD test was a genetic test for my children."
It was a test of the tumour. Your children's risk depends on what you inherited, which only a germline test shows. Do not share the HRD report as if it answered that.
Being straight with you
What this page cannot tell you
It cannot tell you whether your HRD result means an inherited fault, or whether a PARP inhibitor is right for you. The first needs a germline test. The second is your oncologist's decision, based on the cancer, its stage and your earlier treatment.
It cannot read the numbers on your report
Different labs measure scarring in different ways, and their cut-offs differ. What your specific variant or score means is a question for the oncologist or counsellor who ordered the test.
Who this does not apply to
Most people with cancer are never offered an HRD test. It is used mainly in ovarian cancer. In other cancers, BRCA status is usually tested directly, and evidence for HRD scores there is still developing.
The practical side in India
HRD testing is costly, and some labs send samples abroad. Insurance and schemes such as Aarogyasri may not cover it, so ask before the tissue is sent. An old or small block can fail the test.
Holding an HRD report and unsure what it means for your family? Call the helpline. We will help you get the right answer.Questions we are asked
Common questions about HRD testing and BRCA
Is an HRD test the same as a BRCA test?
No. An HRD test checks whether the tumour has lost a repair system, and it usually reports tumour BRCA status too. A germline BRCA test checks your blood for a fault you were born with. Both can matter for treatment. Only the germline test speaks for the family.
My HRD result is positive. Should my daughter be tested?
Not yet. First you need a germline test on your own blood. If it shows an inherited fault, your daughter can be offered a simple test for that exact fault, usually once she is an adult. If it does not, the HRD result says nothing about her.
My HRD result is negative. Can I still carry a BRCA fault?
It is less likely, but possible. That is why germline testing in ovarian cancer does not depend on the HRD result. If you have not had a blood test, ask your oncologist whether you should. Your family history matters as well.
In which cancers is HRD tested?
Mainly in ovarian cancer, and related cancers of the fallopian tube and the lining of the abdomen. In breast, prostate and pancreatic cancer, doctors usually test BRCA directly instead. Your oncologist will say whether an HRD test is useful in your case.
Does the HRD result decide whether I get a PARP inhibitor?
It is one important factor, not the only one. Your oncologist also weighs the cancer type, how it responded to chemotherapy, your BRCA status and your general health. The medicines themselves are explained on our targeted therapy pages.
My report says BRCA1 methylation. What does that mean?
It means BRCA1 was switched off inside the tumour by a chemical tag, not broken by a spelling change. This is usually not inherited. Your counsellor will explain what it means for you, and whether a blood test is still advised.
Can an HRD test fail?
Yes. The tissue may be too small, too old or contain too few cancer cells. The report will then say the result could not be given. Your oncologist may try another block or another sample, or plan treatment without it.
Do I still need genetic counselling after an HRD test?
Yes, if a germline test is being offered or has found a fault. The counsellor explains what an inherited result means for you and your relatives, and writes a family letter if needed. The HRD test itself does not replace that conversation.
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
- National Cancer Institute — BRCA Gene Changes: Cancer Risk and Genetic Testing
- National Cancer Institute — Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ), Patient Version
- GeneReviews (NCBI) — BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer
- National Cancer Institute — Biomarker Testing for Cancer Treatment
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
How tumour and germline testing fit togetherThe two kinds of test, and how they hand overWhen a tumour result triggers a germline testWhich tumour findings should lead to a blood testOvarian cancer: why everyone is offered testingWhy germline testing does not wait for the HRD resultHereditary breast and ovarian cancer explainedWhat an inherited BRCA fault means for a family
Talk to us
Does your HRD result mean anything for your family?
Tell us what your HRD report says and whether you have had a blood test. We will explain what is still unanswered and who can answer it. One helpline serves every CION centre.