BACKGROUND Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk. METHODS We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base. RESULTS A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001). CONCLUSIONS ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate. SUMMARY This study uses the National Cancer Data Base to analyze compliance with the NCCN guidelines for Oncotype DX. Compliance with testing was thirty-six percent. Several factors influenced testing in our study, including facility type, racial and socio-economic factors.