What Is the Oncotype DX Test for Early-Stage Breast Cancer?

This valuable diagnostic test can help determine your treatment plan

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Woman pointing to area on mammogram x-ray, close-up
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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, as well. It's a genomic test that's used to:

  • Figure out how the recurrence risk of early-stage, estrogen-receptor-positive breast cancer
  • How likely you are to benefit from chemotherapy following surgery for breast cancer
  • If you have ductal carcinoma in situ (DCIS), whether you're likely to benefit from radiation (although this use is not yet part of standard care)

Purpose of Test

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

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. The results of these tests affect your treatment options. Tests are for:

All of these test results produce a diagnosis, but without genetic information, your risk of recurrence is difficult to determine. Adding your genetic information to all of this via the Oncotype DX test provides a clearer picture of whether you need chemotherapy to keep your breast cancer from coming back.


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 other 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 under-insured, you may want to contact the company about financial assistance.

Interpreting Results

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 (18-30)
  • 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 (39-54)
  • 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.


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 for recurrence.

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.

A Word From Verywell

As you recover from cancer surgery, 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 through treatment that's specifically tailored to your risk. That can help you move forward with treatment confident that you're doing what's necessary and not enduring treatments you don't need.

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