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Estrogen Receptor (ER) Positive Breast Cancer
ER-positive breast cancer is a common type of breast cancer diagnosed in men and women. Understanding how it's staged and treated may help you seek the support you need.
When breast cancer cells test positive for estrogen receptors, it's called estrogen receptor-positive (ER-positive) breast cancer. It means that estrogen is fueling the growth of the cancer.
It's one of several important characteristics of breast cancer that help determine the best treatment options.
In this article, we'll examine the role of hormone receptors in breast cancer and how they affect treatment and give you a general idea of what to expect.
ER-positive breast cancer is the most common type of breast cancer diagnosed today.
According to the American Cancer Society (ACS), about 2 out of every 3 cases of breast cancer are hormone receptor-positive. Most of these cases are ER-positive, meaning that there are estrogen receptors on the surface of the cell that bind to estrogen.
About 80% of breast cancers in women and 90% of breast cancers in men are ER-positive, according to the National Cancer Institute.
How many ER-positive cases are also PR-positive?
Progesterone receptor-positive (PR-positive) breast cancer means that the cancer is using progesterone as fuel. According to BreastCancer.Org, about 65% of ER-positive breast cancers are also PR-positive.
Only about 1% of breast cancers are PR-positive but ER-negative.
Estrogen and progesterone are the two hormones associated with breast cancer. If the cancer has either or both receptors, it's also known as hormone-positive or HR-positive breast cancer. Breast cancers that test negative for both hormone receptors are HR-negative.
Breast cancer is also checked for a protein called human epidermal growth factor receptor 2 (HER2). Too much of this protein can help cancer grow and spread. These cancers are called HER2-positive or HER2-negative.
Breast cancer can also be triple-positive or triple-negative. This means the cancer is either positive or negative for all three of the receptors mentioned earlier.
Hormones are chemical messengers that circulate in the bloodstream. Hormone receptors are proteins located in and around breast cells. When the corresponding hormone binds to its receptor, it tells the cells how to grow and divide.
In the case of breast cancer, these receptors allow abnormal cells to grow out of control, which results in a tumor.
What are estrogen and progesterone receptors?
Estrogen and progesterone are two hormones that can help breast cancer grow. These hormones bind to estrogen and progesterone receptors.
Following a breast biopsy, a pathologist will perform an immunohistochemical staining assay on the tissue sample. This test can detect the presence of estrogen and progesterone receptors.
Hormone receptor status provides a lot of information on how the cancer is likely to behave. It's also a key factor in determining the best possible treatment.
HR-positive breast cancer typically responds well to hormone therapy. These therapies block the production of the hormones or interfere with their effects on breast cancer cells.
On the other hand, HR-negative breast cancers don't respond to hormone therapy, so other treatment options will be more effective.
If your doctor suspects breast cancer, you will likely have a biopsy to test for cancerous cells. If they are found, your doctor will also test the cells for characteristics that include what receptors, if any, are present on the surface of the cancer cells.
The outcome of this testing is important when making treatment decisions. What treatment options are available is highly dependent on the test results.
If you have ER-positive breast cancer, your cancer cells grow in the presence of the hormone estrogen. Estrogen occurs naturally in the body. Drugs that interfere with estrogen's ability to promote cancer cell growth are used to treat ER-positive breast cancers.
Your outlook depends on the stage of the cancer when it's discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning, and stage 4 is the last stage. Stage 4 is also called the metastatic stage because it's when cancer has spread to other areas in the body.
Each number reflects different characteristics of your breast cancer. These characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.
Research on survival statistics in people with breast cancer tends to separate participants into categories of women and men.
Survival statistics for women with the major subtypes of breast cancer — such as ER-positive, HER2-positive, and triple-negative — are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a typical life span.
Survival rates are based on how many people are still alive years after they first received a diagnosis. Five-year and 10-year survival are commonly reported.
5-year survival rates
It's important to note that these statistics include women with more aggressive HER2-positive and triple-negative cancers.
Research suggests that HR-positive breast cancer is usually associated with a better chance of survival. Also, as it takes 5 years to determine the 5-year statistical survival rate, the effect of newer therapies is not taken into account in these numbers.
It's likely that a person receiving a diagnosis of ER-positive breast cancer today may have a higher chance of survival.
These numbers are based on women diagnosed with breast cancer between 2013 and 2019. Stage 0 is not invasive cancer and is not included in these survival statistics.
These numbers are based on men diagnosed with cancer of the breast between 2012 and 2018.
There are a few different treatment methods for ER-positive breast cancer. All patients with ER-positive breast cancer will be recommended a type of hormone therapy, also known as endocrine therapy.
Often, breast cancer requires a combination of treatments.
Hormone therapy
Hormone treatment aims to prevent estrogen from activating cancer cell growth. This can be accomplished in a few ways, including:
Blocking estrogen receptors
Suppressing ovarian function
The specific hormone therapy for you will likely depend on whether you're premenopausal or postmenopausal. Hormone therapy can start before or after surgery and may continue for 5 years or more.
Surgery
Most women with early stage breast cancer will have surgery before starting hormone therapy. Surgical options will vary depending on:
You can either have part or all of the breast tissue removed. A lumpectomy removes breast tissue, but not the entire breast. A mastectomy removes the entire breast.
Most women will likely also have one or more lymph nodes removed from under the arm. Depending on what type of surgery you have, you may also need radiation, which uses high-energy rays to kill leftover breast cancer cells.
Chemotherapy
An Oncotype DX test can show whether chemotherapy will be beneficial and reduce your risk of relapse. The test examines 21 genes in cancerous tumors to identify the potential relapse rate.
If you have a low recurrence score, you will likely not need chemotherapy. If you have a high recurrence score, you will likely need chemotherapy, surgery, and hormone therapy.
The Oncotype DX test, which may be paid for by Medicare and most insurance plans, is recommended for women who have early stage breast cancer that is:
Chemotherapy uses powerful drugs delivered through the veins or taken as a pill over the course of several weeks or months. These drugs are designed to kill cancer cells.
ER-positive breast cancer has a high chance of being successfully treated, especially when it's discovered early. A diagnosis at a later stage will have a less positive outlook, but people typically receive a diagnosis earlier.
There are still many treatment options for late-stage cancer.
The outlook for women with ER-positive breast cancer is generally good, and there are effective treatments. The chances for a long life are excellent.
When Cancer Spreads: What To Know About Metastatic Breast Cancer
Get the facts about metastasis, as well as learn about some of the myths about the condition, from the editors of PEOPLE and Verywell Health
If you've been diagnosed with early-stage breast cancer, you may be grappling with the idea that the cancer can get worse. Experts say that 20 to 30 percent of people with an early diagnosis eventually graduate to Stage IV, known as Metastatic Breast Cancer (MBC), at some point.
When that happens, the cancer that originated in the breast or nearby lymph nodes moves into other areas of the body, such as the bones, liver, or brain. The health outlook becomes infinitely more complex and the cancer more unpredictable, which can trigger great stress for patients. But the forecast isn't always dire. Here, we address five myths about MBC.
1. It's always terminal.People often assume that being diagnosed with MBC automatically means they will die. That's not necessarily true.
"We have so many better treatments for breast cancer nowadays—even for more aggressive types of breast cancer," said surgeon Anne Peled, MD, co-director of the Breast Care Center of Excellence at Sutter Health California Pacific Medical Center, in San Francisco. "I've had several patients who are alive and doing well many years after finding out that their cancer was metastatic."
Chemotherapy isn't the only treatment option for MBC, either, she pointed out; in some cases, hormone-blocking therapy or immunotherapy is indicated.
2. It can be cured.Unlike early-stage breast cancer, MBC can't really be cured. But it can be managed as a chronic condition, with treatments that focus on controlling the spread, alleviating symptoms, and improving patients' quality of life. It's true that people living with MBC will be in treatment for the rest of their lives. That being said, there are many cases where patients who've undergone treatment for breast cancer no longer have any visible signs of the disease, so it is "treatable." There are a variety of regimens and clinical trials out there, and many approaches can be tried.
"It is important that patients with MBC receive personalized treatment plans from a multidisciplinary treatment team," said Vivian Jolley Bea, MD, the section chief of breast surgical oncology at New York-Presbyterian Brooklyn Methodist Hospital, in Brooklyn, New York. "No two MBCs are the same, so understanding details about the type of breast cancer [a person has] and their treatment options is key to alleviating unnecessary stress."
Related: Stars Who Have Had Breast Cancer and Shared Their Stories
3. It's inevitable.Most people with early-stage breast cancer do not develop MBC, according to experts at Johns Hopkins Medicine, in Baltimore.
"In general, when breast cancer is diagnosed at a more advanced stage, there is an increased risk of it coming back as metastatic cancer in the future, as compared to earlier stages," said Dr. Peled. As a breast cancer survivor, she knows what it's like to fear potential metastasis. "While I know rationally that the risk for me is low, I still start worrying every time I have a new symptom, like persistent back pain." If it doesn't go away in a few weeks, she gets it checked out—and recommends that anyone with similar anxieties consult with their oncologist, too.
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Stock image of a mother with cancer 4. It's your fault.This idea preoccupies some patients with MBC, said Dr. Bea: "They think that if they had caught it earlier, they [might] not have been diagnosed. The truth is that metastatic breast cancer can still occur, even if normal screening recommendations have been followed."
Mammograms and ultrasounds can improve breast cancer outcomes, but they can't eliminate a cancer that has already metastasized. Factors like tumor subtype and genetic factors often play a larger role in determining metastatic potential. You can develop MBC even if you've been diagnosed and followed all treatment guidelines perfectly.
"Catching breast cancer at its earliest stage is important, but the biology of the tumor is perhaps even more important," Dr. Bea explained. "Tumor biology often dictates how cancer cells act and determines what their metastatic potential is."
Related: From When to Get Tested to What Got Them Through: What Women Who Have Had Breast Cancer Want You to Know
5. You need to keep a positive attitude.Maintaining a good attitude helps when fighting cancer, but it isn't everything. You also need comprehensive treatment and support.
Too often, patients living with breast cancer will avoid discussing new symptoms with their oncologists because they're afraid of an MBC diagnosis, and a shorter life expectancy. That's a bad idea.
If you're feeling scared, reach out to breast cancer support groups, networks, and online communities, urged Dr. Peled. Speaking to others who've been there can lessen your fear. Valuable resources include METAvivor, a site that offers support and education to those dealing with Stage IV breast cancer, and The Breasties, an organization that provides community for those with breast and gynecologic cancers.
"Counseling and psycho-oncologic therapy—provided by psychologists who specialize in treating cancer patients—are also excellent options," added Dr. Bea.
Medical ReviewMedically Reviewed by Sohaib Imtiaz, MD, Verywell Health Chief Medical Officer
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