Oncotype DX

Oncotype DX is a test that predicts how likely breast cancer is to spread to somewhere else in the body. It’s suitable for some people who will be taking hormone therapy for at least 5 years.

Oncotype DX can help your treatment team decide whether you would benefit from having chemotherapy.

Oncotype DX may be suitable if you’ve recently been diagnosed with:

• Early stage invasive breast cancer
• That is oestrogen receptor positive (ER-positive)
• And HER2-negative 

If cancer is in 1 to 3 lymph nodes

If breast cancer has spread to 1 to 3 lymph nodes under the arm, Oncotype DX may be offered to:

• Women who have been through the menopause
• Men
• Some trans, non-binary or intersex people

If there’s no cancer in the lymph nodes

Oncotype DX may be offered to help you decide whether to have chemotherapy if:

• Breast cancer has not spread to any lymph nodes, or if a small amount of cancer is in the lymph nodes (micrometastases)
• And you’ve been told you have an intermediate risk of breast cancer spreading to another part of the body

Your specialist may recommend the Oncotype DX test if the benefit of chemotherapy for you is less clear.

Chemotherapy may be given after surgery to reduce the risk of breast cancer coming back in future.

Whether you’re offered chemotherapy depends on a number of features of your breast cancer. These include:

• The size and grade of the cancer
• Whether it has spread to any of the lymph nodes under the arm
• Whether the cancer is hormone receptor and HER2 positive or negative

For some people the benefit of chemotherapy is clear, but for others it’s less clear.

How the test is done

The test is done on a small amount of breast cancer tissue already removed (for example during a core biopsy or surgery).

The tissue is sent to a laboratory in the USA, where the test is carried out. The test looks at groups of genes found in breast cancer.

If your specialist has recommended you have hormone therapy before surgery, the test must be done on the tissue removed by a core biopsy before you start hormone therapy.

How long results take

The results are given separately from your pathology report and are sent to your specialist within 10 to 14 days.

The test gives a score, known as a Recurrence Score, from 0 to 100. 

The higher the score, the more likely breast cancer is to come back and the more likely you are to benefit from having chemotherapy as well as hormone therapy. 

Your specialist will use the score, along with other information about your breast cancer, to help decide whether chemotherapy would benefit you. 

If you're over the age of 50

If you're over 50 a score of:

• 0 to 25 means you’re unlikely to benefit from having chemotherapy in addition to hormone therapy
• 26 to 100 means you’re likely to benefit from having chemotherapy in addition to hormone therapy

If you're aged 50 or younger

If you're aged 50 or under a score of:

• 0 to 15 means you’re unlikely to benefit from having chemotherapy in addition to hormone therapy
• 16 to 100 means your specialist will discuss your test result with you to help decide if you’re likely to benefit from chemotherapy

If Oncotype DX is suitable for you, it’s usually available on the NHS across the UK.

Most private healthcare companies will also cover the cost of the test. 

You can also pay for the test yourself. Your treatment team will need to order the test for you and will be sent the results to discuss with you. It costs around £3,000. 

There’s a specific Oncotype DX test for people with ductal carcinoma in situ (DCIS) who have had breast-conserving surgery.

It’s not routinely used on the NHS as there’s less evidence of its benefits for people with DCIS. Some private healthcare providers may cover the cost and you can also pay for the test yourself. For more information, talk to your treatment team.

Oncotype DX for DCIS can predict the risk of the cancer coming back after surgery. The results of this test may help you and your treatment team decide whether you’re likely to benefit from radiotherapy.