What Is the Oncotype DX Test?

What to expect when undergoing this test

In This Article

The Oncotype DX test is an important tool for doctors as they design treatments that not only manage breast cancer but keep it from coming back. Specifically, it's a genomic test that's used to figure out the likelihood that early-stage, estrogen receptor-positive breast cancer is to recur, assess how likely someone is to benefit from chemotherapy after breast cancer surgery, and determine whether someone could benefit from radiation for ductal carcinoma in situ, DCIS (although this use is not yet part of standard care).

Purpose of Test

This test examines samples of your tumor tissue and rates the activity of a specific set of genes that can influence the risk of recurrence within 10 years of your original diagnosis. This rating is called your recurrence score.

The Oncotype DX tests your blood and tissue in several ways to determine your unique diagnosis.

You're likely a candidate for this test if you're considering chemotherapy for cancer that is:

Other tests can produce a diagnosis of breast cancer, but without the genetic information that Oncotype DX provides, your risk of recurrence is difficult to determine. Thus, this test provides a clearer picture of whether you need chemotherapy to keep your breast cancer from coming back.

However, this test does not tell your doctor which type of chemotherapy drugs to use, whether you need Herceptin, or whether you will need radiation therapy. Those decisions will be based on the results of other tests.

Risks

This test is performed on tumor tissues that were already collected during surgery or biopsy, so it carries no additional risks for you.

Cost and Health Insurance

Medicare and several private health insurance companies will help cover the cost of an Oncotype DX test for invasive breast cancer. For DCIS, Medicare has established coverage of the Oncotype DX, but insurance companies may not yet cover it.

Check with your insurance provider to find out if you are covered for this test and how much of the bill, if any, you may responsible for.

The test is analyzed and provided by Genomic Health. If you're uninsured or underinsured, you may want to contact the company about financial assistance.

Interpreting Results

Recurrence scores differ depending on the type of cancer being tested.

Recurrence Score: Invasive Breast Cancer

Your recurrence score for invasive breast cancer is based on the genetic expression of 21 genes, 16 of which are cancer-related and five of which are for reference.

The genes are grouped by function: proliferation, invasion, hormone receptors (estrogen and progesterone), and growth factors. Each person's test results will be unique, but will fall into one of three categories:

  • Low risk: Under 18
  • Intermediate risk: 18 to 30
  • High risk: 31 or higher

If you have a low risk of recurrence, you may not need chemotherapy at all and may be able to go straight from surgery to hormone therapy.

If you're in the intermediate to high-risk categories, the benefits of chemotherapy may be considered greater than the risk. You may also need hormone therapy to further reduce your risk of recurrence.

Recurrence Score: DCIS

For DCIS, the Oncotype DX looks at 12 genes. Results are:

  • Low risk: Under 39
  • Intermediate risk: 39 to 54
  • High risk: 55 or higher

The higher the recurrence score, the more likely it is that the benefits of radiation will outweigh the risks.

However, research on this test for DCIS is in its early stages and this test is not yet part of standard care for that condition.

Next Steps

Once you know your recurrence score, it's time to make treatment decisions with your doctor and get started with the new treatment regimen.

Many other factors—like age, tumor grade, and hormone receptor status—should be considered before you decide on a treatment plan, but research has shown that results from the Oncotype DX test are a very strong predictor of recurrence.

Breast Cancer Doctor Discussion Guide

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A Word From Verywell

Recurrence is probably the last thing you want to think about. However, forewarned is forearmed, and the Oncotype DX can give you peace of mind by informing treatment that's specifically tailored to your risk. That can help you move forward with confidence that you're doing what's necessary—and not enduring treatments you don't need.

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Article Sources

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  1. McVeigh TP, Hughes LM, Miller N, et al. The impact of Oncotype DX testing on breast cancer management and chemotherapy prescribing patterns in a tertiary referral centreEur J Cancer. 2014;50(16):2763–2770. doi:10.1016/j.ejca.2014.08.002

  2. Yuan Y, Dyke ALV, Kurian AW, Negoita S, Petkov VI. Oncotype DX DCIS use and clinical utility: A SEER population-based studyJournal of Clinical Oncology. 2019;37(15_suppl). doi:10.1200/jco.2019.37.15_suppl.e12046.