The gene expression test is a way ofpersonalized medicine- a way to learn more about your cancer and adapt your treatment.
These tests are performed on breast cancer cells after surgery or a biopsy to look at the patterns of many different genes. This process or test is sometimes calledgene expression profiling.
What do the test results mean?
The patterns found can help predict whether certain early breast cancers are likely to return after initial treatment.
Some gene expression tests/profiling can help predict which women are most likely to benefitchemotherapyafter breast surgery (adjuvant chemotherapy).hormone treatmentIt is a standard treatment for hormone receptor-positive breast cancer, but it is not always clear when to use chemotherapy. These tests can help guide that decision. Still, these tests cannot tell any woman for sure whether the cancer will come back with or without chemotherapy.
These tests continue to be widely studied.clinical trialsto better understand how and when to best use them. In the meantime, ask your doctor if these tests might be helpful for you.
OOncotype DX,MammaPrint e Prosignaare examples of tests that look at different sets of breast cancer genes to see if chemotherapy is needed to help reduce the risk of the cancer coming back (recurring). More tests are under development. The type of test used depends on your situation. Keep in mind that these tests are used for early-stage cancers and testing is not necessary in all cases. For example, if the breast cancer is advanced, it may be clear that chemotherapy is needed even without gene expression testing.
The Oncotype DX test is used for stage I, II or IIIahormone receptor positive tumorsthat has not spread to more than 3 lymph nodes and isHER2 negative. It can also be used forDCIS (ductal carcinoma in situ or stage 0 breast cancer).
This test looks at a set of 21 genes in cancer cells from tumor biopsy or surgical samples to obtain a "recurrence score", which is a number between 0 and 100. The score reflects the risk of the breast cancer coming back (recurring). in the next 9 years, if you are treated with hormone therapy alone, and how likely you are to benefit from chemotherapy after surgery.
For women over 50 and without cancerous lymph nodes:
- A low score (0-25) means a low risk of recurrence. Most women with low recurrence scores do not benefit from chemotherapy and have good results when treated with hormone therapy.
- A high score (26-100) means a higher risk of recurrence. Women with high recurrence scores are more likely to benefit from adding chemotherapy to hormone therapy to help reduce the chance that the cancer will return.
For women age 50 and younger and without cancerous lymph nodes:
- A low score (0-15) means a low risk of recurrence. Most of these women with low recurrence scores do not benefit from chemotherapy and have good results when treated with hormone therapy.
- An average score (16-25)means that some women in this group may slightly benefit from adding chemotherapy to hormone therapy to reduce the risk of the cancer returning. Talk to your doctor about options.
- A high score (26-100) means a higher risk of recurrence. Women with high recurrence scores are more likely to benefit from adding chemotherapy to hormone therapy to help reduce the chance that the cancer will return.
For women age 50 and younger who have cancer of the lymph nodes:
- A low score (0-25) means a lower risk of recurrence,but women in this group may benefit from adding chemotherapy to hormone therapy. Another possibility could beovarian suppression along with tamoxifen or an aromatase inhibitor.
- A high score (26-100) means a higher risk of recurrence. Women in this group are more likely to benefit from adding chemotherapy to hormone therapy to reduce the chance that the cancer will return.
The MammaPrint test can be used to determine how likely breast cancer is to return in a distant part of the body after treatment. It can be used for any type of invasive breast cancer that is 5 cm (about 2 inches) or less and has spread to no more than 3 lymph nodes. This test can be done regardless of the woman's age, cancer hormone or HER2 status.
The test looks at 70 different genes to determine whether the cancer has a low or high risk of coming back (recurring) within the next 10 years. Test results come back as "low risk" or "high risk". This test is also being studied as a way to determine whether certain women might benefit from chemotherapy.
The Prosigna test can be used to predict the risk of recurrence over the next 10 years in postmenopausal (menopausal) women whose invasive breast cancers are hormone receptor positive and HER2 negative. It can be used to test for early-stage cancers that have not spread to lymph nodes or early-stage cancers with no more than 3 positive lymph nodes.
The test analyzes 50 genes and classifies the results as low, medium or high risk.
Breast Cancer Index
The breast cancer index test is performed on your tumor sample from the time you are first diagnosed. It can be used to predict the risk of recurrence 5 to 10 years after diagnosis in women whose invasive breast cancers are hormone receptor positive and have not spread to nearby lymph nodes or have not spread to more than 3 lymph nodes.It can also help predict who might benefit from hormone therapy over 5 years.
The test analyzes 11 genes and classifies the results as low or high risk.
- Written by
American Cancer Society Medical Content and Editorial Team Our team is made up of oncology doctors and nurses with in-depth knowledge of cancer treatment, as well as journalists, editors and translators with extensive experience in medical writing.
American Cancer Society Medical Content and Editorial Team
Our team is made up of oncology doctors and nurses with in-depth knowledge of cancer treatment, as well as journalists, editors and translators with extensive experience in medical writing.
Cardoso F, van't Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S et al. Signature of 70 genes to aid treatment decisions in early-stage breast cancer.N Engl J Med. 2016;375(8):717-29. Foukakis T, Bergh J and Hurvitz SA. Deciding when to use adjuvant chemotherapy for hormone receptor positive and HER2 negative breast cancer. In Vora SR, ed.Updated. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Last updated August 17, 2021. Accessed September 14, 2021. Gnant M, Filipits M, Dubsky P, et al. Predicting the risk of late metastasis: the PAM50 risk of recurrence score (ROR) after 5 years of endocrine therapy in postmenopausal women with HR+ early breast cancer: a study of 1478 patients for the ABCSG-8 study.Ana Oncol.2013; 24 (Supl 3): iii29-iii37.
Cardoso F, van't Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S et al. Signature of 70 genes to aid treatment decisions in early-stage breast cancer.N Engl J Med. 2016;375(8):717-29.
Foukakis T, Bergh J and Hurvitz SA. Deciding when to use adjuvant chemotherapy for hormone receptor positive and HER2 negative breast cancer. In Vora SR, ed.Updated. Waltham, Mass.: UpToDate, 2021. https://www.uptodate.com. Last updated August 17, 2021. Accessed September 14, 2021.
Gnant M, Filipits M, Dubsky P, et al. Predicting the risk of late metastasis: the PAM50 risk of recurrence score (ROR) after 5 years of endocrine therapy in postmenopausal women with HR+ early breast cancer: a study of 1478 patients for the ABCSG-8 study.Ana Oncol.2013; 24 (Supl 3): iii29-iii37.
Harris LN, Ismaila N, McShane LM, et al. Use of biomarkers to guide decisions about adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline.J Clin Oncol. 2016;34(10):1134-1150.
Knauer M, Mook S, Rutgers EJ, Bender RA, Hauptmann M, van de Vijver MJ et al. The predictive value of a 70-gene signature for adjuvant chemotherapy in early breast cancer.Breast cancer treatment Res.2010 abr;120(3):655-61.
Corpo I, Ismaila N, André F, et al. Use of biomarkers to guide decisions about adjuvant systemic therapy for women with early-stage invasive breast cancer: a focused update on clinical practice guidelines from the American Society of Clinical Oncology.J Clin Oncol. 2017;35(24):2838-2847.
National Comprehensive Cancer Network (NCCN). Practical Guidelines in Oncology: Breast Cancer. Version 8.2021. Accessed from https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf on September 14, 2021.
Paik, S. Development and clinical utility of a prognostic analysis of 21-gene recurrence scores in patients with early breast cancer treated with tamoxifen.oncologists. 2007;12(6): 631-635.
Sparano JA, Gray RJ, Makower KI, Pritchard KS, Albain DF, Hayes CE, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer.N Engl J Med. 2018;379(2):111-121.
Sparano JA, Gray RJ, Ravdin PM, Makower DF, Pritchard KI, Albain KS et al. Clinical and genomic risk to guide or use of adjuvant therapy in non-breast cancer.N Engl J Med. 2019;380(25):2395-2405.
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Last revision:November 8, 2021
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Which gene testing is recommended for breast cancer? ›
Genetic testing for hereditary breast and ovarian cancer looks for mutations in the BRCA1 and BRCA2 genes. Your doctor might suggest testing using a multigene panel, which looks for mutations in several genes at the same time, including BRCA1 and BRCA2.Is genetic testing for breast cancer worth it? ›
Finding out you have a genetic mutation means you can help prevent breast cancer or find it early, when your chances for successful treatment are highest. But your decision won't just affect you. Your test results also could predict your family member's cancer risks.What is the highest Oncotype score? ›
The Oncotype DX test is used to assign each women's cancer a score for recurrence risk on a scale of 0‒100.What are the emotions of breast cancer patients? ›
The feelings that come up after a breast cancer diagnosis can sometimes mirror the five stages of grief identified by psychiatrist Elisabeth Kübler-Ross in 1969. These may be familiar to you, and include denial, anger, bargaining, sadness and depression, and acceptance.What is the most reliable test for breast cancer? ›
A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspicious area.What are the disadvantages of genetic testing? ›
- Testing may increase your stress and anxiety.
- Results in some cases may return inconclusive or uncertain.
- Negative impact on family and personal relationships.
- You might not be eligible if you do not fit certain criteria required for testing.
|Type of Cancer||Mutated Gene||Cost|
|Gastric Cancer Panel||19-gene panel||$540|
A positive test result indicates that a person has inherited a known harmful variant in BRCA1 or BRCA2 (these are typically called “pathogenic” or “likely pathogenic” variants on laboratory test reports) and has an increased risk of developing certain cancers.What oncotype score requires chemo? ›
A score of 26 or above means you're likely to benefit from having chemotherapy in addition to hormone therapy.Does age affect Oncotype score? ›
Oncotype DX recurrence score and mortality
Cumulative risk of mortality increased with advanced age, regardless of receipt of chemotherapy (Fig. 3). Women who received adjuvant chemotherapy had a lower cumulative mortality risk.
What is the minimum tumor size for oncotype? ›
When can Oncotype DX be used? Oncotype DX helps predict the chance of future metastasis and the likelihood of benefit from chemotherapy for early breast cancers that are all of the following [14,31]: Tumor size smaller than 5 cm. ER-positive (and will be treated with hormone therapy)What not to say to breast cancer patients? ›
- Do not burst into tears. ...
- Do not avoid talking about the subject. ...
- Do not invade. ...
- Do not send YOUR thoughts by post. ...
- Do not offer prayers. ...
- Do not say 'Let me know what I can do' ...
- Do not stop sending out invites. ...
- Do not try to kid us how well we look.
|SEER Stage||5-year Relative Survival Rate|
|All SEER stages combined||91%|
Most people report a good quality of life after they complete breast cancer treatment [8-10]. However, you may have some late effects of treatment. You may have some long-term side effects or new side effects may occur months or even years after treatment ends.Why is left breast cancer more common? ›
Potential reasons behind this statistic include larger left breast size, more frequent self-screening of left breast, and right-side breastfeeding preferences.What is the new treatment for breast cancer? ›
The new drug, elacestrant, addresses a significant unmet need. It is the first and only treatment approved specifically to fight breast cancers with mutations in an estrogen receptor called ESR1, which make breast cancers resistant to standard endocrine therapy.When are you considered cancer free after breast cancer? ›
If you are going to celebrate your survivorship with early-stage breast cancer, your oncologist may say that the best date for describing yourself as a survivor is the day that you completed your initial treatment, including surgery and possibly chemotherapy and/or radiation therapy.What is the newest breast cancer test? ›
Digital breast tomosynthesis (also called DBT or 3-D mammography) has become the new standard of care for breast cancer screening since it was approved by the U.S. Food and Drug Administration in 2011, detecting on average 25 percent more cancers per 1,000 women when compared to 2-D mammography.Which breast cancer diagnosis has the best prognosis? ›
Non-invasive (stage 0) and early-stage invasive breast cancers (stages I and II) have a better prognosis than later stage cancers (stages III and IV). Breast cancer that's only in the breast and has not spread to the lymph nodes has a better prognosis than breast cancer that's spread to the lymph nodes.How fast can breast cancer develop between mammograms? ›
On average, breast cancers double in size every 180 days, or about every 6 months. Still, the rate of growth for any specific cancer will depend on many factors.
Why is genetic testing not recommended? ›
In some cases, genetic testing creates tension within a family because the results can reveal information about other family members in addition to the person who is tested. The possibility of genetic discrimination in employment or insurance is also a concern.Why are genetic tests never 100% reliable? ›
In some cases, a test result might not give any useful information. This type of result is called uninformative, indeterminate, inconclusive, or ambiguous. Uninformative test results sometimes occur because everyone has common, natural variations in their DNA, called polymorphisms, that do not affect health.What is unethical about genetic testing? ›
In a large number of instances, when patients receive the results of genetic tests, they are party to information that directly concerns their biologic relatives as well. This familial quality of genetic information raises ethical quandaries for physicians, particularly related to their duty of confidentiality.Why is genetic testing not covered by insurance? ›
Passed in 2008, a federal law called the Genetic Information Nondiscrimination Act (GINA) made it illegal for health insurance providers in the United States to use genetic information in decisions about a person's health insurance eligibility or coverage.Does insurance cover getting tested for the BRCA gene? ›
In the United States, BRCA testing is usually covered by insurance if the patient meets certain criteria. Insurance coverage and criteria varies by insurance plan, and genetic counselors will review potential costs and insurance coverage with you during your appointment.Does United Healthcare cover genetic testing for breast cancer? ›
UnitedHealthcare also covers the BRCA test without cost sharing for certain members who are women 18 years of age or older with a family history of ovarian and/or breast cancer, or a personal history of ovarian and/or breast cancer. 6.Why did I get estrogen positive breast cancer? ›
Lifetime exposure: Females with a longer lifetime exposure to estrogen and progesterone may have a higher risk of developing hormone receptor-positive breast cancer. This includes people who: start menstruating early. reach menopause late.Should I get a mastectomy if I have the BRCA gene? ›
These options have risks and benefits, and you should discuss them with a doctor knowledgeable about medical management for women with BRCA1 or BRCA2 mutations. The most effective option for preventing cancer is surgery to remove the breasts (mastectomy) and ovaries and fallopian tubes (salpingo-oophorectomy).Can breast cancer change from positive to negative? ›
The characteristics of a breast cancer -- including hormone receptor status and HER2 status -- can change over time. These changes may happen because the cancer cells change themselves or because treatment changes the cells. A cancer's characteristics determine which treatments will offer the most benefit.What Oncotype score is low risk? ›
Recurrence Score of 0–25: The cancer has a low risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects. Recurrence Score of 26–100: The cancer has a high risk of recurrence.
Has anyone had recurrence with low oncotype? ›
Background: Oncotype RS is used to assess recurrence risk and predict chemotherapy benefit for hormone positive, node negative, early stage breast cancer. There is a predicted recurrence rate of 6.8% at 10 years with an RS of less than 18, considered low, with the use of hormonal treatment alone.What is a bad Oncotype score? ›
A score between 0 and 25 means you have a low risk of the cancer returning if you get hormone treatment. With this score you probably will not benefit from receiving chemotherapy. A score between 26 and 100 means you have a higher risk that the disease might come back.How reliable is Oncotype? ›
How accurate is Oncotype DX testing? Many studies have validated the accuracy of Oncotype DX testing for invasive breast cancer. The NCCN guidelines list the level of evidence of Oncotype DX testing for predicting chemotherapy benefit in postmenopausal women as level 1, which is the highest level.What are the limitations of Oncotype? ›
Clearly, Oncotype DX has limitations such as false-positives and false-negatives - as every test - and the final decision making process with the patient is more complex than a test score and its associated recommendation.Who is a candidate for Oncotype? ›
Who Can Have the Oncotype DX Test? Candidates for this test typically have early-stage breast cancer (stage I or II) that is: • Estrogen-receptor positive (ER+) breast cancer. Human epidermal growth factor protein negative (HER2 -).How long does it take to get the results of an Oncotype? ›
The Oncotype DX Test does not require the patient to have any additional surgery or procedure. Most results are available within a week to 10 days from the date the tumor sample is received by the laboratory that analyzes it.What is the cost of Oncotype DX test? ›
|Item||Mean cost (USD)|
|Oncotype DX test||5141|
|Endocrine therapy (years 1–5)||256.5|
|Endocrine therapy (years 6–8)||289.6|
The Oncotype DX is a test that may predict how likely it is that your breast cancer will return. It also predicts whether you will benefit from having chemotherapy in addition to hormone therapy. The test results can help you and your doctors make a treatment plan that's right for you.What not to do to avoid breast cancer? ›
- Keep Weight in Check.
- Be Physically Active.
- Eat Your Fruits & Vegetables – and Limit Alcohol (Zero is Best)
- Don't Smoke.
- Breastfeed, If Possible.
- Avoid Birth Control Pills, Particularly After Age 35 or If You Smoke.
- Avoid Hormone Therapy for Menopause.
- Tamoxifen and Raloxifene for Women at High Risk.
Since the mid-20th century, many unhealthy changes have affected diet, lifestyle, obesity, the environment and our microbiomes. Those changes may now be occurring earlier in life and may be making humans more susceptible to cancer at a younger age.
What is the prayer against breast cancer? ›
I ask you, Mary, Our Lady of Sorrows, to be with me (or someone I love) as they battle with breast cancer. Pray with me (us) for strength and comfort, courage, and healing.Is breast cancer ever completely cured? ›
Treatment for breast cancer will be successful for most people, and the risk of recurrence gets less as time goes on. Recurrence, unfortunately, can happen even many years after treatment, so no one can say with certainty that you're definitely cured.Which type of breast cancer is most likely to recur? ›
Aggressive, hard-to-treat breast cancers, such as inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC), are the types most likely to recur.What is the easiest breast cancer to treat? ›
NONINVASIVE BREAST CANCER
“Ductal” refers to the milk ducts in the breast, and “in situ” means “in its original place.” DCIS is a stage 0 cancer, which is the earliest and generally the most treatable form of breast cancer.
Radiation therapy involves giving high doses of radiation beams directly into a tumor. The radiation beams change the DNA makeup of the tumor, causing it to shrink or die. This type of cancer treatment has fewer side effects than chemotherapy since it only targets one area of the body.What cancers are common after breast cancer? ›
- Salivary gland cancer.
- Esophagus cancer.
- Stomach cancer.
- Colon cancer.
- Uterine cancer.
- Ovarian cancer.
- Thyroid cancer.
- Soft tissue cancer (sarcoma)
Stage 2 breast cancer means that the cancer is either in the breast or in the nearby lymph nodes or both. It is an early stage breast cancer.What age should you get tested for BRCA gene? ›
Genetic testing for BRCA1 or BRCA2 mutations is typically not recommended for children younger than 18, but can be considered when your children reach adulthood. Younger children might not be able to understand what your mutation means for you or for them.Which is worse BRCA1 or BRCA2? ›
BRCA1 carriers have a worse overall survival than BRCA2 patients . Studies do show that women who carry BRCA mutations are more likely to develop secondary cancer - either in the same breast or the contralateral breast.What is the difference between BRCA1 and 2? ›
Differences Between BRCA1 and BRCA2
Both mutations increase the risk of ovarian cancer, as well as pancreatic cancer. A BRCA1 mutation can also increase the risk of cervical, uterine, and colon cancer, while BRCA2 can increase the likelihood of stomach, gallbladder, and bile duct cancer, plus melanoma.
How accurate is 23 and me for BRCA? ›
It also showed greater than 99 percent reproducibility and repeatability. Keep in mind that because this is an at-home test it is important to confirm results in a clinical setting before taking any medical action. Learn more.How much does it cost to get tested for the BRCA gene? ›
Without insurance, BRCA testing can range from roughly $300 to $5,000 or more, depending on copayments, coinsurance, lab fees, and more.Should you get a mastectomy if you have the BRCA gene? ›
These options have risks and benefits, and you should discuss them with a doctor knowledgeable about medical management for women with BRCA1 or BRCA2 mutations. The most effective option for preventing cancer is surgery to remove the breasts (mastectomy) and ovaries and fallopian tubes (salpingo-oophorectomy).Does BRCA gene come from mother or father? ›
Everyone has two copies of the BRCA1 and BRCA2 genes, one copy inherited from their mother and one from their father. Even if a person inherits a BRCA1 or BRCA2 mutation from one parent, they still have the normal copy of the BRCA1 or BRCA2 gene from the other parent.What is the life expectancy of someone with BRCA1? ›
With no intervention, the remaining life expectancy of a 30, 40 and 50 year-old BRCA1 mutation carrier who has never had cancer, is 41.5, 32.7 and 26.1 years, respectively; the remaining life expectancies of BRCA2 mutation carriers of the same ages are 48.6, 39.4 and 30.7 years.What to do if you are BRCA1 positive? ›
If you test positive for a BRCA1 or BRCA2 gene mutation, you can ask your doctor whether it makes sense to: start breast cancer screening at a younger age (as young as 25 or even younger if a family member has been diagnosed with breast cancer before age 30)Can one sister have the BRCA gene and not the other? ›
Everyone carries 2 copies of BRCA genes inherited from his or her mother and father. If 1 parent has a BRCA mutation, all of his or her children have a 50% chance of inheriting that mutation. Even if a child inherits only 1 mutated BRCA gene, that person's risk of developing cancer increases.What is the life expectancy of someone with BRCA2? ›
Of those who died before 70 years, 58% were due to ovarian cancer, 38% to breast cancer, and 3% to other causes. In contrast, only 156 of 482 (32%) of BRCA2 carriers had died, with 131 (84%) dying before age 70. Of these deaths, 21% were due to ovarian cancer, 74% to breast cancer, and 4% to other causes (Table 2).What cancers does BRCA2 cause? ›
- breast cancer.
- ovarian cancer.
- prostate cancer.
- pancreatic cancer.
The most commonly reported cancers with BRCA2 mutations include pancreas, prostate, and melanoma.
What are my options if I test positive for BRCA gene? ›
Some women who test positive for harmful BRCA1 and BRCA2 variants may choose to start breast cancer screening at younger ages, have more frequent screening than is recommended for women with an average risk of breast cancer, or have screening with magnetic resonance imaging (MRI) in addition to mammography.Can I take estrogen if I have the BRCA gene? ›
Again, it is important to know that if you have been diagnosed with breast cancer, you should not take HRT. If you're a premenopausal woman with a BRCA1 mutation, you may be considering oophorectomy to reduce your risk of both breast and ovarian cancer.What are the odds of testing positive for BRCA? ›
About 1 in every 500 women in the United States has a mutation in either her BRCA1 or BRCA2 gene. If either your mother or your father has a BRCA1 or BRCA2 gene mutation, you have a 50% chance of having the same gene mutation.