CION Ameerpet
HRD testing looks at the tumour rather than the genes you were born with — and it identifies a considerably larger group of women who benefit from certain treatments than BRCA testing alone does.
Homologous recombination is one of the ways cells repair a serious kind of DNA damage — a break across both strands of the double helix. It is the pathway BRCA1 and BRCA2 work in. Homologous recombination deficiency, or HRD, simply means that pathway is not working in a particular tumour.
The crucial difference from a BRCA test is what is being tested. A germline BRCA test examines the genes you inherited, using blood or saliva, and tells you about risk you were born with and can pass on. HRD testing examines the tumour itself, and asks a different question: is this cancer's repair machinery broken, however it came to be broken?
That wider question catches considerably more. A tumour can be HRD-positive because of an inherited BRCA variant, or because a BRCA variant arose within the tumour alone, or because a different gene in the same pathway is faulty, or because the genome shows the characteristic pattern of scarring that broken repair leaves behind. Roughly half of high-grade serous ovarian cancers turn out to be HRD-positive — a much larger group than those with an inherited BRCA variant.
Blood or saliva. Tells you about risk you were born with, and what your relatives might carry.
Tumour tissue. Asks whether this cancer's repair pathway is broken, by any mechanism.
Roughly half of high-grade serous ovarian cancers are HRD-positive, far more than carry an inherited BRCA variant.
A broken repair pathway is a weakness that treatment can exploit. Cells have more than one way to repair DNA; when homologous recombination is lost, the cell leans heavily on a backup route. Blocking that backup — which is what PARP-inhibitor-class drugs do — leaves the cancer cell with no working repair at all, while healthy cells with intact homologous recombination carry on largely unaffected. The same logic explains why HRD tumours respond well to platinum-based chemotherapy, which works by damaging DNA. The defect that helped cause the cancer is the thing that makes it treatable. Source: NCCN Ovarian Cancer guidelines.
These are frequently confused, and they answer genuinely different questions. Knowing which you have had matters.
| What is tested | What it tells you | |
|---|---|---|
| Germline BRCA test | Blood or saliva — the genes you inherited. | Your inherited risk, and what your children and siblings may carry. |
| Somatic tumour test | Tumour tissue — variants present in the cancer. | Whether a BRCA variant is present in the tumour, inherited or acquired. |
| HRD test | Tumour tissue — pathway function and genomic scarring. | Whether the repair pathway is broken by any mechanism. |
| What it means for family | Directly relevant — cascade testing follows. | A variant found may be tumour-only; germline testing clarifies. |
| What it means for treatment | Guides platinum and maintenance therapy decisions. | Widens the group eligible for maintenance therapy. |
| When it is done | At diagnosis, offered to essentially all women. | At or shortly after diagnosis, on tissue already removed. |
*A BRCA variant found on tumour testing may be somatic (tumour-only) or germline (inherited). Only a germline test on blood or saliva distinguishes them — which matters enormously for your relatives.
This is a treatment test more than a risk test, and it changes real decisions about what happens next.
This is the main reason the test is done. After first-line chemotherapy, maintenance therapy aims to extend the period before the cancer returns. PARP-inhibitor-class drugs are the principal option, and their benefit is greatest in tumours with a broken homologous recombination pathway.
An HRD-positive result therefore opens a treatment option that would not otherwise be considered, and it does so for a considerably wider group than BRCA testing alone identifies. At CION this maintenance treatment is delivered in-house, across more than 35 centres.
Platinum-based chemotherapy works by damaging tumour DNA, and a cell that cannot repair that damage properly is more likely to die. HRD-positive tumours are therefore typically more platinum-sensitive, which is reflected in how well they respond to first-line treatment and to re-treatment if the disease returns.
This also shapes decisions at relapse. A tumour that responded well and relapsed after a long interval is treated differently from one that progressed on platinum, and HRD status is part of how that picture is understood.
A substantial number of women with a negative inherited BRCA test still have an HRD-positive tumour. Their cancer has broken repair machinery — through a variant that arose in the tumour alone, through another pathway gene, or through the genomic scarring pattern — but they inherited nothing.
Without HRD testing those women are simply told their BRCA test was negative, and a maintenance option that could apply to them is never raised. This is the single strongest argument for HRD testing being part of the standard work-up rather than an optional extra.
This is an important distinction that causes real confusion. An HRD-positive result is a statement about the tumour, not about the genes you inherited, so it does not by itself mean your children or siblings are at increased risk.
If a BRCA variant is found on tumour testing, a separate germline test on blood or saliva is needed to establish whether it was inherited or arose only in the cancer. That distinction determines whether cascade testing of relatives is warranted. See cascade testing.
HRD testing is most relevant in high-grade serous ovarian cancer, which is where HRD is most prevalent and where the maintenance treatment evidence is strongest. It is generally performed on tissue already removed at surgery or obtained by biopsy, so it usually requires no additional procedure.
Adequate, well-preserved tissue is needed for the assay to work, which is one reason how a biopsy is taken and handled matters. Where a test fails for tissue reasons, it is worth asking whether it can be repeated on a different sample rather than treating the question as closed. See high-grade serous ovarian cancer.
It means the tumour's homologous recombination pathway appears to be functioning, so the specific benefit that HRD-positive tumours derive from PARP-inhibitor-class maintenance is less pronounced. It does not mean maintenance therapy is necessarily excluded, and it does not mean treatment will not work.
It is genuinely useful information, because it helps avoid a treatment with real side effects in a group less likely to gain substantially from it. Treatment decisions are made on the whole picture — stage, response to chemotherapy, general health and your own preferences — not on this one result.
These come up constantly and are frequently not covered unless asked. All are reasonable.
Tumour testing and inherited testing answer different questions. Both matter, and having one does not cover the other.
A negative BRCA test does not exclude an HRD-positive tumour, and HRD identifies a considerably larger group.
A BRCA variant on tumour testing may be tumour-only. Only a germline blood test tells your relatives anything.
The main practical purpose of the test. Ask specifically what it opens or closes for you.
HRD assays need adequate tissue and can fail. A failed test is not a negative result, and repeating it may be possible.
Only germline findings are relevant here. Genetic counselling establishes what, if anything, your family needs.
A failed or inconclusive HRD assay is not the same as an HRD-negative result. If yours failed for tissue reasons, ask whether it can be repeated on another sample.
Many women whose inherited BRCA test is negative still have an HRD-positive tumour — and that finding opens maintenance treatment options that would otherwise never be discussed.
We're never more than 30 minutes away. Same panel of specialists at every centre. Same tumour board reviews. Same NCCN protocols. Pick the closest one and call directly — or let us pick for you.
CION Ameerpet
CION Kukatpally
CION L.B. Nagar
CION Tolichowki
CION Masab Tank
CION Banjara Hills
CION Kompally
CION Balanagar
CION Siddipet
CION Sangareddy
Not sure which centre fits best? Tell us where you are — we'll suggest the closest one with the right specialists.
Help me pick the right centreTravelling for treatment? We may have a centre right where you are.
Don't see your city? Call 18002028726 — we'll find your nearest CION partner centre.
Trained at AIIMS, Tata Memorial and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them - together.
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationShare your name and number — we'll call you back within 30 minutes to schedule your consultation.
No referral needed and no cost for the first consultation. BRCA and HRD testing and genetic counselling are delivered in-house at CION.
This is one of the areas where CION delivers the whole chain itself. BRCA and HRD testing and genetic counselling are in-house, and so is the maintenance therapy that an HRD-positive result opens up. That matters practically, because the alternative is a test arranged in one place, interpreted in another, and acted on somewhere else again — with weeks lost between each step at a point when weeks matter.
Your first consultation is free and runs to about 45 minutes. If you have already been tested, bring the reports — both the germline result and the tumour report if you have them, since they answer different questions and people frequently have one without realising the other exists. If you have not been tested, the useful conversation is what each test would tell you and when it should be done.
Chemotherapy and PARP-inhibitor-class maintenance therapy are delivered in-house at CION across more than 35 centres in Telangana and Andhra Pradesh, so treatment can continue near where you live rather than requiring repeated travel. Debulking surgery and other gynaecologic-oncology surgery is coordinated with specialist partner centres and may be billed there — we state that upfront rather than leaving it to be discovered later.
Testing, counselling and the maintenance therapy it opens all delivered by CION rather than across separate referrals.
Germline and tumour testing answer different questions. Bring both reports if you have them.
PARP-inhibitor-class maintenance delivered across 35+ centres in Telangana and Andhra Pradesh.
Debulking and other gynaecologic-oncology surgery is performed at specialist partner centres and may be billed there.
Most of this happens on tissue that has already been removed, so it rarely requires anything extra from you.
Usually from the tumour removed at debulking surgery, or from a biopsy taken to establish the diagnosis. In most cases no additional procedure is needed, because suitable tissue already exists in the pathology archive.
The assay looks for two things: variants in BRCA1, BRCA2 and other homologous recombination pathway genes, and the characteristic pattern of genomic instability that a long-broken repair pathway leaves behind. A tumour can be HRD-positive on either basis.
A separate blood or saliva test establishes what you inherited. This is offered to essentially all women with epithelial ovarian cancer regardless of family history, because it guides your own treatment as well as informing relatives about their risk.
The HRD result is interpreted alongside stage, histology, how the cancer responded to chemotherapy and your general health. At CION every case that raises a question is reviewed by a multidisciplinary group rather than decided by one clinician.
Where the tumour is HRD-positive and there has been a good response to platinum-based chemotherapy, PARP-inhibitor-class maintenance therapy is discussed — including its benefits, its side effects and how long it would continue. This is a decision to make with full information, not a default.
Where the inherited test is positive, counselling covers what it means for you and for relatives, and how cascade testing works. This is delivered in-house at CION. See BRCA and ovarian cancer.
They test different things and answer different questions. A germline BRCA test examines the genes you inherited, using blood or saliva, and tells you about risk you were born with and what your relatives may carry. HRD testing examines the tumour itself and asks whether that cancer's DNA repair pathway is broken — by any mechanism, including a variant that arose only in the tumour, a fault in a different pathway gene, or the pattern of genomic scarring that broken repair leaves behind. HRD identifies a considerably larger group than inherited BRCA testing does.
Yes, and this happens frequently — it is the strongest argument for HRD testing being routine rather than optional. A negative inherited BRCA test only means you did not inherit a BRCA variant. Your tumour can still have broken homologous recombination repair through a BRCA variant that arose within the cancer itself, through a fault in another gene in the same pathway, or through the characteristic genomic instability pattern. Without HRD testing, those women are simply told their BRCA test was negative and a maintenance treatment option that could apply to them is never raised.
Principally, it opens up maintenance therapy. After first-line chemotherapy, PARP-inhibitor-class drugs are used to extend the period before the cancer returns, and their benefit is greatest in tumours with a broken homologous recombination pathway. An HRD-positive result also indicates that the tumour is likely to be more sensitive to platinum-based chemotherapy, since platinum works by damaging DNA that the cell then cannot repair. Both of these are delivered in-house at CION across more than 35 centres.
Not by itself, and this distinction matters. HRD is a statement about the tumour, not about the genes you were born with, so an HRD-positive result alone says nothing about what your children or siblings may have inherited. If a BRCA variant is identified on tumour testing, a separate germline test on blood or saliva is needed to establish whether that variant was inherited or arose only within the cancer. Only an inherited variant is relevant to your relatives, and genetic counselling establishes what, if anything, cascade testing should follow.
No. It means the tumour's homologous recombination pathway appears to be working, so the particular benefit that HRD-positive tumours derive from PARP-inhibitor-class maintenance therapy is less pronounced. It does not mean maintenance is necessarily excluded, and it certainly does not mean treatment will not work. It is genuinely useful information, because it helps avoid committing to a treatment with real side effects in a group less likely to gain substantially. Treatment decisions rest on the whole picture — stage, chemotherapy response, general health and your own preferences.
Almost never. HRD testing is performed on tumour tissue that has usually already been removed — either at debulking surgery or through the biopsy taken to establish the diagnosis — and that tissue is retained in the pathology archive. What the assay does need is adequate, well-preserved material, which is why how a biopsy is taken and handled matters. If a test fails for tissue reasons, that is not the same as a negative result, and it is worth asking whether it can be repeated on a different sample.
Yes — BRCA and HRD testing and genetic counselling are delivered in-house at CION, and so is the PARP-inhibitor-class maintenance therapy that an HRD-positive result opens up. That means the test, its interpretation and the treatment decision all happen with the same team rather than across separate referrals with weeks lost between them. The first consultation is free and runs to about 45 minutes. Debulking and other gynaecologic-oncology surgery is coordinated with specialist partner centres and may be billed there, and we state that upfront.