Research table: Estrogen receptor status and overall survival

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Some breast cancer cells need estrogen (a hormone produced in the body) to grow. These cancer cells have special proteins inside, called estrogen receptors.

When hormones attach to estrogen receptors, the cancer cells with these receptors grow.

A pathologist determines the estrogen receptor status by testing the tumor tissue removed during a biopsy. The standard of care is to test all breast cancers for estrogen receptor status.

• Estrogen receptor-positive (ER-positive) tumors express estrogen receptors. This means they have a lot of estrogen receptors.
• Estrogen receptor-negative (ER-negative) tumors do not express estrogen receptors. This means they have few or no estrogen receptors.

Estrogen receptor status helps guide breast cancer treatment. ER-positive breast cancers can be treated with hormone therapies such as tamoxifen, aromatase inhibitors and ovarian suppression.

Learn more about estrogen receptor status.

Prognosis (chance of survival)

People with ER-positive early breast cancers tend to have better survival than people with ER-negative early breast cancers [1].

As the studies below show, 5-year survival after diagnosis is about 10 percent better for women with ER-positive early breast cancer than for those with ER-negative early breast cancer.

After about 5 years, this survival difference begins to decrease and over time, goes away [1].

Learn about factors that affect breast cancer prognosis and help guide treatment.

Learn about the strengths and weaknesses of different types of studies.  

Study selection criteria: Prospective cohort studies with at least 1,500 participants and at least 5 years of follow-up. 

Study	Study Population (number of participants)	Characteristics of Breast Cancer	Follow-up (years)	5-Year Overall Survival
				ER-Positive	ER-Negative
Prospective cohort studies
SEER [4]	111,993	Stage I, II or III*	8	Women younger than 40: 90%†Sig Women 40-49: 94%†Sig Women 50-59: 95%†Sig Women 60-69: 95%†Sig Women 70-74: 94%†Sig	Women younger than 40: 78%†Sig Women 40-49: 81%†Sig Women 50-59: 81%†Sig Women 60-79: 81%†Sig Women 70-74: 80%†Sig
Danish Breast Cancer Cooperative Group [2]	26,944	Grade I, II or III	5	85%‡	69%‡
Truong et al. [5]	8,038	T1-2 Grade I, II or III	4-6	Higher survival Sig	Lower survival Sig
Sopik et al. [6]	1,910	Stage I, II or II*	15	95%†,§	80%†,§
Jayasekara et al. [7]	1,196	Stage I, II or III*	15	89%¶	78%¶

Sig = Statistically significant difference in survival

NS = No statistically significant difference in survival

cm = centimeter

* Breast cancer stage classified before 2018.

† Rates are for breast cancer survival (death from breast cancer), not overall survival (death from any cause).

‡ For the 3,591 women for whom 10-year survival data were available, 10-year survival was 68% for women with ER-positive tumors and 57% for women with ER-negative tumors.

§ Rates are estimated from a figure. Breast cancer survival at 15 years was 77% for women with ER-positive tumors and 70% for women with ER-negative tumors.

¶ Overall survival at 10 years was 77% for women with ER-positive tumors and 68% for women with ER-negative tumors.

References

1. Moffat FL. Chapter 28: Clinical and pathologic prognostic and predictive factors, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 5th edition, Lippincott Williams & Wilkins, 2014.
2. Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast cancer Study. JAMA. 295(21):24922502, 2006.
3. Yu KD, Wu J, Shen ZZ, Shao ZM. Hazard of breast cancer-specific mortality among women with estrogen receptor-positive breast cancer after five years from diagnosis: implication for extended endocrine therapy. J Clin Endocrinol Metab. 97(12):E2201-9, 2012.
4. Truong PT, Bernstein V, Wai, E, et al. Age-related variations in the use of axillary dissection: A survival analysis of 8038 women with T1-ST2 breast cancer. Int J Radiat Oncol Biol Phys. 54(3):794-803, 2002.
5. Sopik V, Sun P, Narod SA. The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients. Breast Cancer Res Treat. 165(2):391-402, 2017. 
6. Jayasekara H, MacInnis RJ, Chamberlain JA, et al. Mortality after breast cancer as a function of time since diagnosis by estrogen receptor status and age at diagnosis. Int J Cancer. 145(12):3207-3217, 2019.

Updated 08/01/22