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Utility of 21-Gene Recurrence Score in Male Breast Cancer
Matthew G Hager1, Tanya L Hoskin2, Kathryn J Ruddy3
1Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA.
Annals of Surgical Oncology
|May 11, 2026
Summary
Recurrence score (RS) testing is increasingly used in male breast cancer patients. Male patients with high RS scores were less likely to receive chemotherapy and experienced worse overall survival when it was omitted.
Area of Science:
- Oncology
- Genomic Medicine
- Clinical Research
Background:
- The 21-gene Recurrence Score (RS) (Oncotype DX) predicts breast cancer recurrence risk and chemotherapy benefit in females.
- RS has not been extensively studied in male breast cancer patients.
Purpose of the Study:
- To evaluate the usage and prognostic implications of RS testing in male breast cancer patients.
- To compare RS usage and outcomes between male and female breast cancer patients.
Main Methods:
- Utilized the National Cancer Database (NCDB) from 2010-2023.
- Included male and female patients with pT1-2, N0-1, ER+, HER2- breast cancer.
- Analyzed RS usage trends, chemotherapy receipt, and overall survival (OS) using chi-squared tests and Cox regression.
Main Results:
- RS testing increased significantly for both sexes from 2010-2023, with higher rates in males by 2023.
- Male patients with RS ≥ 26 were more common (19% vs. 14%) and less likely to receive chemotherapy (68% vs. 77%) compared to females.
- Male patients with RS ≥ 26 had significantly poorer OS when chemotherapy was omitted, particularly those under 65.
Conclusions:
- RS testing is increasingly adopted in male breast cancer and influences chemotherapy decisions.
- Male patients with high RS scores face worse outcomes if chemotherapy is omitted, highlighting its importance.
