For decades, a breast cancer diagnosis almost always came with the same grim certainty: chemotherapy. Even if physicians suspected chemo wouldn’t necessarily make a difference in outcomes for some early-stage patients (especially those with HR-positive, HER2-negative tumors), without a reliable way to measure how likely a patient’s cancer was to recur, the standard of care was to err on the side of caution. According to Christy Russell, MD, Vice President, U.S. medical affairs at Exact Sciences, even if a patient was reluctant to take on the physical and emotional burden of chemotherapy, “it was easy to say, ‘Don’t you want to do everything you can to prevent this cancer from coming back?’ And then there would be a guilt factor for the patient.”
But in the early 2000s, something happened that completely changed the standard of care for breast cancer patients forever.
As the scientific community began to use the newly understood tool of gene sequencing, the Oncotype DX Breast Recurrence Score® test was born. The test analyzes the genes in a patient’s tumor. “Of the 20,000 genes in every cell, we look at 16 of them and assess how they’re functioning,” Dr. Russell tells us. “We then put those results into a mathematical formula and end up with an Oncotype DX Breast Recurrence Score result ranging from 0 to 100.” The higher the score, the more likely the patient’s cancer is to benefit from chemotherapy.
Given that physicians had long operated under a “better safe than sorry” approach, the results were striking: Roughly 70 percent of women diagnosed with early-stage breast cancer may be able to safely forego chemotherapy and all its difficult side effects. While that offers enormous relief for the majority of patients, for the other 30 percent, the test provides something equally vital — clarity, and a treatment plan grounded in precision.
“It’s a trade-off — the short-term impact chemo has on your life and body versus the long-term risk that your cancer might come back,” says Dr. Russell. “But you also have to weigh that against the long-term toxicity of chemotherapy drugs, some of which can cause neuropathy or, in rare cases, congestive heart failure or acute leukemia.”
For fitness instructor and mother of four Tara Hayes, even before getting her Recurrence Score® result, that potential trade-off caused major stress. When she was diagnosed with invasive lobular breast cancer in 2022, Hayes was stunned — and she’d already experienced enough health battles for one lifetime. “I have cardiomyopathy and a heart arrhythmia, and I had open-heart surgery when I was three,” she tells us. “At my first appointment, my surgeon said she really hoped I wouldn’t need chemo because it would be really bad for my heart.”
After a double mastectomy, Hayes received her Recurrence Score® results: Her score was 11, meaning she would likely not benefit from chemotherapy. To be sure, she sought a second opinion, and another specialist confirmed the same result. “When you’re facing mortality, you want to make sure you get it right,” she remembers. “So when I got that confirmation, I was ecstatic. They’re still learning about the effects of my heart surgery four decades later, and chemo could have been toxic for me. Before this test, I would have been faced with an impossible decision.”
Despite her positive prognosis, Hayes still has complicated feelings about her diagnosis. “There’s a lot of anger still there,” she says. “I’d led such a well-balanced life. I did everything you’re supposed to do to stay healthy, and cancer still got me. But learning my Recurrence Score® and having that science-backed assurance that I likely wouldn’t benefit from chemo was the one silver lining in all of it.”
At age 35, Air Force veteran Kara Kenan also had a lot on her plate. “I was teaching English at a local college, I’d just gotten married and we were still in the process of moving in together, and my four-year-old daughter was dealing with a pretty significant medical issue that required surgery,” she recalls. “So I was already going through a lot when I found a lump in my breast.”
After consulting her mother — and learning she had a family history of breast cancer — Kenan scheduled a mammogram, followed by a biopsy. A few days later, her doctor called. “She said, ‘Are you sitting down?’ and I started laughing,” Kenan says. “I just couldn’t believe it. After we hung up, I called my mom, and she said, ‘I’m on my way.’ And that’s how it started.”
“Before I got my score, I was terrified that I’d find out I needed chemo,” says Kenan. “But I’ve always been very data-driven, and my doctor explained that this test was the most accurate way to make an informed treatment decision.” Kenan’s Recurrence Score® was 29, indicating that she would likely benefit from chemotherapy. “When I learned my score, I was actually sort of relieved,” she says. “It meant I was making the choice to get chemo based on data about me — not just general statistics.”
Kenan’s chemotherapy was grueling. Over six months of treatment, she lost her hair and experienced such intense bone pain that all she could do was lie in bed and pray for relief. But through that physical trauma, she discovered something about herself: “My body was stronger than I could have ever imagined.”
During chemo, Kenan focused on surviving one day at a time. But once treatment ended, anxiety began to creep in. “Suddenly I was seeing my oncologist every three months instead of every week,” she remembers. “That’s when the fear of recurrence started. How will they know if it’s come back? So I really clung to that Recurrence Score® result. It gave me peace of mind that whatever happens, I did everything I possibly could to keep myself healthy. There was power in that.”
It’s been 12 years since Kenan’s diagnosis, and she’s had her share of ups and downs. Two years ago, she had a metastatic scare that turned out to be a false alarm — just scarring left from chemo. But today, Kenan remains cancer-free. “I’ve worked through a lot of that fear and anxiety, and in general, I’m thriving,” she says. “I’ve gotten into advocacy work, and it’s given me an incredible sense of purpose to take what I’ve learned and use it to help other people. It’s the best sisterhood you never wanted to be part of.”
She also credits the Oncotype DX test for saving her life. “Were it not for my Recurrence Score® result, I’m positive I would not have agreed to get chemo,” she says. “And if I hadn’t, there’s a chance I wouldn’t be here today.”
For both Kenan and Hayes, the Oncotype DX test offered something that was once impossible — confidence in a deeply personal decision. As breast cancer treatment continues to evolve, that clarity may be one of medicine’s most powerful gifts.
Tara Hayes and Kara Kenan are both patient story ambassadors for Exact Sciences.
