A gene test which can identify which patients with low-risk breast cancer need chemotherapy and which don’t could save the NHS around £4 million a year if it was used more widely, according to an analysis using data from a major UCL clinical trial. The Prosigna genomic test is approved by the National Institute for Health and Clinical Excellence (NICE), the body which advises the NHS about medicines, but only for use with post-menopausal women in England, Wales and Northern Ireland whose breast cancer has not spread to more than three of their lymph nodes and post-menopausal women in Scotland whose cancer has not spread to any lymph nodes.In May, new results from the UCL-led Optimal Personalised Treatment of early breast cancer using Multi-parameter Analysis (OPTIMA) trial revealed that two-thirds (67%) of the 4,429 participants got a low score using the Prosigna test, indicating that they could be treated safely with hormone therapy alone. Analysis of OPTIMA trial At a presentation at the European Society for Medical Oncology Congress 2026 in Madrid, Peter Hall, from the Institute of Genetics and Cancer, revealed how much money test-directed chemotherapy could save the NHS based on data from the randomised controlled OPTIMA trial.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 those, about 6,200 have the type of breast cancer studied in the OPTIMA trial and are given chemotherapy as the standard treatment.These patients are aged 40 or over, their cancer is hormone-sensitive and HER2-negative and has either spread to up to nine lymph nodes or formed a tumour of 30mm or more. In the trial, the test showed that 67% of these patients did not need chemotherapy. Across the UK, that is about 4,200 people a year, Similarly, in the trial, chemotherapy cost the NHS about £5,500 for each patient given it as their standard treatment. That figure covers the drugs, nurse and day-unit time, medicines for side effects and hospital admissions. Testing cut chemotherapy spending by £3,611 for every patient tested. Professor Peter Hall Personal Chair of Medical Oncology (Cancer Informatics) Typically, the Prosigna test costs around £1,955 per NHS patient in the UK at list price. After considering other factors such as any additional costs that might have been incurred from those who skip chemotherapy to start other treatments sooner, Professor Hall calculated that the NHS saves around £654 for every person who had the Prosigna test within the two years of being diagnosed.That means that over the course of a year, if the NHS gave the test to all the eligible patients for the OPTIMA trial, it would save around £4 million from those who recorded low test scores not needing to have chemotherapy. 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 the effect of rare, expensive to treat, late chemotherapy side effects. Dr Rob Stein Professor of Breast Oncology at UCL and OPTIMA trial Chief Investigator How the Prosigna test works Chemotherapy is regularly offered to people with early‑stage breast cancer that has spread from the breast to nearby lymph nodes, as it lowers the risk of the disease returning.While effective overall, there is concern among clinicians that many people with the most common, hormone‑sensitive type of breast cancer receive little or no benefit from chemotherapy but still experience its significant and sometimes dangerous side effects. These include fatigue, nausea and vomiting, hair loss and also a weakened immune system which can increase the risk of infection.The Prosigna genomic test, made by US cancer diagnostics firm Veracyte, addresses this dilemma.The test analyses a piece of tumour already removed during standard surgery or a biopsy and measures the activity of a group of 50 genes involved in breast cancer growth in the sample.It then assigns the tumour a score related to the risk of the cancer spreading – women with a low score are judged not to need chemotherapy. The OPTIMA trial information UCL is the sponsor of the OPTIMA trial and had overall responsibility for the study. The University of Warwick coordinated trial delivery and led data collection and analysis.Key contributions also came from teams at the Universities of Edinburgh, Leeds and Bristol, alongside international partners at Oslo University Hospital in Norway and Breast Cancer Trials of Australia and New Zealand.In total, 115 hospitals throughout the UK, 11 in Norway and Sweden, 44 in Australia and New Zealand and one in Thailand recruited patients.The trial was funded by more than £5.7 million in grants from the National Institute for Health and Care Research (NIHR) to UCL. Veracyte provided approximately £1.8 million in additional funding and testing support. International partners were supported by local funding sources, including cancer charities. Related links Peter Hall’s Research Group The ESMO 2026 Congress Tags 2026 This article was published on Monday 26 October 2026
