Fig. 1: Flow charts reporting the possible uses of 21-gene recurrence score and for the 70-gene signature test to guide the use of adjuvant chemotherapy in patients with early invasive breast cancer, hormone receptor-positive, HER-2 negative.

Two strategies are proposed for 21-gene recurrence score, the first in which all women are tested for genomic risk assessment and treated accordingly, the second in which only women with high clinical risk are tested for genomic assessment, while those at low clinical risk are referred to endocrine therapy alone without genomic risk assessment. According to sub-group considerations reported by the GDG, the latter strategy is probably more cost effective and women might experience larger net desirable consequences. For the 70-gene signature only a two-step strategy is proposed where only women at high clinical risk are tested for genomic risk; testing women at low clinical risk is not recommended.