BACKGROUND: Half of all breast cancers are early stage, lymph node negative, and 
hormone receptor positive. A 21-gene (Oncotype DX®; Genomic Health, Inc., 
Redwood City, CA) recurrence score (RS) is prognostic for recurrence and 
predictive of chemotherapy benefit. We explored the ability of oncologists to 
predict the RS using standard prognostic criteria.
METHODS: Standard demographic and tumor prognostic criteria were obtained from 
patients with an available RS. Two academic pathologists provided tumor grade, 
histologic type, and hormone receptor status. Six academic oncologists predicted 
the RS category (low, intermediate, or high) and provided a recommendation for 
therapy. The oncologists were then given the actual RS and provided 
recommendations for therapy. Analysis for agreement was performed.
RESULTS: Thirty-one cases, including nine additional cases with variant 
pathology reads, were presented. There was substantial agreement in oncologists' 
ability to discriminate between true low or true intermediate and true high (κ = 
0.75; p < .0001). Predictions between low and intermediate were not consistent. 
The most common discrepancies were predictions of a low RS risk when cases were 
true intermediate and predictions of an intermediate RS risk when cases were 
true low. The actual RS resulted in a change in the treatment recommendations in 
19% of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer 
chemotherapy recommendations resulted with the actual RS.
CONCLUSIONS: Oncologists are able to differentiate between a low or intermediate 
RS and a high RS using standard prognostic criteria. However, provision of the 
actual RS changed the treatment recommendations in nearly 20% of cases, 
suggesting that the RS may reduce chemotherapy use. This effect was observed in 
particular in intermediate-risk cases. Prospective clinical trials are necessary 
to determine whether decisions based on the RS change outcomes.