The aim of this study was to combine breast MRI-derived biomarkers with clinical-pathological parameters to identify patients who truly need an Oncotype DX Breast Recurrence Score® (ODXRS) genomic assay, currently used to predict the benefit of adjuvant chemotherapy in ER-positive/HER2-negative early breast cancer, with the ultimate goal of customizing therapeutic decisions while reducing healthcare costs. Here, ESR1 is linked to breast cancer.