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Biomarker testing
BRCA vs HRD Testing: — Which Test Decides PARP Inhibitor Eligibility?
BRCA testing and HRD testing both play a role in deciding whether PARP inhibitor medicines such as olaparib or niraparib apply to your cancer. They measure different things, and the one your oncologist orders depends on your cancer type.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Not the same test — BRCA testing finds a specific gene mutation. HRD testing finds a broader repair failure — which may or may not be caused by that mutation.
- Cancer type decides which you need — For ovarian cancer, both tests may matter. For breast, prostate and pancreatic cancer, BRCA testing is usually the primary requirement.
- A negative BRCA result is not the final answer — In ovarian cancer, a BRCA-negative tumour can still qualify for a PARP inhibitor if HRD testing is positive.
- Family implications differ — A positive germline BRCA result has consequences for blood relatives. An HRD result does not.
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BRCA testing looks for mutations in the BRCA1 or BRCA2 genes. HRD testing looks for a broader dysfunction — whether your tumour has lost the ability to repair its own DNA. PARP inhibitors are approved on the basis of either result depending on your cancer type; which test applies to you is decided by your oncologist.
What is the difference between BRCA testing and HRD testing?
BRCA testing checks for mutations in the BRCA1 or BRCA2 genes. These genes normally help your cells repair damaged DNA using a process called homologous recombination. If either gene is mutated, that repair process breaks down. BRCA testing can be done on a blood sample, which finds an inherited mutation, or on tumour tissue, which finds a mutation that developed only in the cancer.
HRD stands for homologous recombination deficiency. It describes a broader problem: your tumour cannot use this DNA repair pathway at all, regardless of the cause. The test looks at patterns of damage across the tumour genome — sometimes called genomic scars — rather than searching for a single gene mutation.
BRCA mutations are one cause of HRD. But HRD can also arise from changes in other genes. A tumour that is BRCA-negative can still be HRD-positive, which is why the two tests are not interchangeable.
Which test will be ordered for your cancer type?
For breast cancer, prostate cancer and pancreatic cancer, NCCN and ESMO guidelines centre eligibility on BRCA mutation testing — usually germline testing from blood, and sometimes somatic testing on tumour tissue as well.
For ovarian cancer, eligibility criteria vary by the specific PARP inhibitor and the approved indication. Some require a BRCA mutation result. Others require an HRD score. Some require both. CDSCO approvals in India and international guidelines from NCCN and ASCO specify which test is needed for each approved use.
If your oncologist has ordered one test but not the other, ask what the other test would add and whether it has already been considered. The answer is often that it is not required for your situation — but it is a fair question to raise.
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What does a negative BRCA result mean for PARP inhibitor eligibility?
A negative BRCA result does not rule out HRD. Some tumours that carry no BRCA mutation still show the genomic scar pattern that HRD testing detects. In ovarian cancer in particular, HRD-positive eligibility criteria exist for certain PARP inhibitors even when BRCA is absent.
If both BRCA and HRD testing return negative, PARP inhibitors are generally not indicated for that tumour at that point. Other treatment pathways remain, and your oncologist will explain which is most appropriate.
Eligibility can also be reconsidered if the disease changes later and a rebiopsy is possible, since tumours can shift their molecular profile over time.
Which PARP inhibitor applies to which test, by cancer type?
- Ovarian cancer — BRCA-mutatedBRCA testing (germline from blood or somatic from tumour tissue) establishes eligibility. PARP inhibitors including olaparib are approved in this setting per NCCN and ESMO guidelines.
- Ovarian cancer — BRCA-negative but HRD-positiveHRD testing on tumour tissue can establish eligibility for certain PARP inhibitors such as niraparib in approved indications. A negative BRCA result alone does not close this route in ovarian cancer.
- Breast cancer, HER2-negativeGermline BRCA testing from a blood sample is the standard eligibility requirement. Olaparib and talazoparib have approvals in germline BRCA-mutated settings per international guidelines.
- Prostate cancerGermline or somatic BRCA mutation — and in some approvals other HRR gene mutations — in tumour tissue determines eligibility. HRD score alone is not the current standard criterion.
- Pancreatic cancerGermline BRCA mutation from a blood test is the standard requirement. HRD testing is not a current eligibility route for this cancer type.
Did you know?
A tumour that tests negative for BRCA mutations can still have homologous recombination deficiency and qualify for a PARP inhibitor. This is why ESMO guidelines for ovarian cancer recommend HRD testing even when BRCA results are negative — BRCA status alone does not fully capture who will respond.
Source: ESMO Clinical Practice Guidelines — Ovarian Cancer
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Common questions
Frequently asked questions
If I have a BRCA mutation, do I still need HRD testing?
Not always, and it depends on your cancer type. For breast, prostate and pancreatic cancer, a BRCA mutation is generally sufficient to establish eligibility and HRD testing adds little to that decision. For ovarian cancer, some approved indications require an HRD score even when BRCA is already positive, while others accept BRCA status alone. Your oncologist will specify which pathway applies to your situation and whether both results are needed.
Can HRD testing replace BRCA testing?
In some ovarian cancer settings it partly can, because HRD testing captures BRCA mutations as well as broader deficiency — a BRCA-mutated tumour will also be HRD-positive. But for breast, prostate and pancreatic cancer, the specific requirement is a BRCA gene mutation, and an HRD score does not substitute for that. They are designed to answer different questions, and for most cancer types outside ovarian cancer, BRCA testing remains the primary requirement.
Is HRD testing available in India?
HRD testing requires tumour tissue and a specialised molecular pathology laboratory. It is available in India through reference laboratories, though not in every city. Your oncologist will arrange for your tissue block to be sent to the relevant laboratory, which may take longer than a local test. Ask your team when the sample will be dispatched and what the expected turnaround is so you can plan the rest of your treatment timeline.
What is the difference between germline and somatic BRCA testing?
Germline testing is done on a blood sample and looks for a mutation you were born with — one present in every cell in your body that can potentially be passed to your children. A positive germline BRCA result has implications for blood relatives who may want to consider testing. Somatic testing is done on tumour tissue and finds a mutation that developed only inside the cancer, with no inherited component. For PARP inhibitor eligibility, both types can qualify depending on the cancer and the approved indication.
My mother had a BRCA mutation. Should I be tested before cancer develops?
Yes, and this is best handled through genetic counselling rather than a general oncology appointment. A BRCA mutation in a first-degree relative is a recognised clinical reason to consider cascade testing. If you carry the same mutation, it changes the surveillance options and risk-reduction strategies available to you. You do not need a cancer diagnosis to be eligible for this assessment — ask your family doctor or an oncologist for a referral to a genetic counsellor.
What treatment options remain if both BRCA and HRD testing are negative?
PARP inhibitors are generally not indicated when both results are negative. That closes one specific pathway, not the overall picture. Depending on your cancer type and stage, chemotherapy, other targeted therapies, immunotherapy, radiation and clinical trials may all remain relevant. Your oncologist will map out what comes next based on the full set of results — a negative biomarker result is the answer to one question, not a summary of what is possible.