Cellular genomic DNA is continuously exposed to endogenous and exogenous factors that induce various forms of DNA damage. In mammalian cells, the daily burden of DNA damage may reach 104–105 lesions per cell. DNA damage that persists into the S phase can lead to mutations. When such mutations occur in oncogenes, tumor suppressor genes, or genes involved in cell proliferation, they may promote cellular transformation and carcinogenesis. Therefore, DNA damage repair plays a critical role in maintaining genomic stability and preventing cancer development. Assessment of DNA repair capacity is best achieved by measuring the functional activity of DNA repair systems. DNA damage repair pathways and their repair efficiencies are highly relevant to chemotherapeutic drug development, gene function validation, and cancer therapy. Accordingly, investigation of the repair efficiency of individual DNA damage repair pathways has important theoretical and practical significance. This review summarizes the major DNA damage repair pathways, methods used to assess repair efficiency, and the advantages and limitations of these approaches.