A genomic test to support treatment decision-making for women with early breast cancer could save the UK National Health Service (NHS) up to £4m ($5.3m) annually if used more widely, according to new research led by University College London (UCL).
The research was presented by Peter Hall, professor of medical oncology at the University of Edinburgh, at the European Society for Medical Oncology (ESMO) Congress 2026, which took place from 23 to 27 October in Madrid, Spain. The UCL-led OPTIMA trial (ISRCTN42400492) enrolled 4,429 patients with hormone-sensitive and HER2-negative breast cancer (HR+/HER2-) that had either spread to up to nine lymph nodes or formed a tumour of 30mm or more.
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Data from the randomised study, first shared at the American Society of Clinical Oncology (ASCO) Annual Meeting in May 2026, demonstrated that 67% of patients with a low risk of recurrence (ROR) score with Prosigna could be treated safely with hormone therapy alone.
Prosigna assay analyses the activity of 50 specific genes (the PAM50 signature) within breast tumour tissue and generates a numerical ROR score that predicts the likelihood of the cancer returning in a different part of the body within 10 years.
In patients with low ROR scores, five years after treatment, the data shared at ASCO demonstrated that 93.6% treated with hormone therapy alone were alive and recurrence-free, versus 94.8% in the control arm who received standard chemotherapy followed by endocrine therapy (CET).
Breast cancer is the most common cancer in women worldwide and around 60,000 women are diagnosed with invasive breast cancer in the UK each year. Of this number, 6,159 have HR+/HER2- breast cancer as studied in the OPTIMA trial and are given chemotherapy as the standard treatment. Reducing the use of chemotherapy could also save patients unnecessary toxicity from treatment if it is not required.
Annual cost-savings could total £4m
Hall noted that in the OPTIMA trial, chemotherapy cost the NHS around £5,500 for each patient given it as their standard treatment. Meanwhile, the Prosigna test, which costs around £1,955 for every NHS patient tested, cut chemotherapy spend by £3,611 per patient tested.
After considering other factors such as any additional costs that might have been incurred from patients who skip chemotherapy to start other treatments sooner, Hall calculated that the NHS saves around £654 for every patient who had the Prosigna test within two years of being diagnosed.
Over the course of a year, therefore, if the NHS gave the test to all eligible women, as per the OPTIMA trials enrolment criteria, it would save around £4m from women who recorded low test scores not needing to have chemotherapy.
Commenting on the analysis, Dr Rob Stein, professor of breast oncology at UCL and OPTIMA trial chief investigator, said: “This analysis reveals that the trial not only shows Prosigna testing allows about two-thirds of patients with oestrogen-sensitive breast cancer to safely avoid chemotherapy, but doing so also saves the NHS money.
“This study only looks at about the first two years from diagnosis. We expect cost savings will be greater when we look at the longer term because of the effect of rare, expensive to treat, late chemotherapy side effects.”
Commercialised by Veracyte, Prosigna received approval from the UK’s National Institute for Health and Care Excellence (NICE) in December 2018, with an updated clearance granted for the assay to include post-menopausal women, men, and trans/non-binary individuals with both lymph node-negative and certain lymph node-positive HR+/HER2- early breast cancers in May 2024.
