ER+/PR+ breast cancer characteristics

Last updated: April 20, 2023

Up to two-thirds of invasive breast cancers are classified as hormone receptor positive (ER+/PR+). Hormone receptor positive breast cancer has both estrogen receptor positive (ER+) and progesterone receptor positive (PR+) tumor receptor status. In other words, the relevant genes cause the cancer cells to express both estrogen and progesterone receptors.

ER+/PR+ breast cancer either overexpresses the HER2 gene (ER+/PR+/HER2+) or not (ER+/PR+/HER2-). Compounds that regulate ER or PR expression, oppose the production of estrogen in the body (i.e., oppose aromatase) or inhibit estrogen binding to estrogen receptors are among those used to treat this type of breast cancer.

ER+/PR+ subtype has the most favorable prognosis

Breast cancer patients with ER+/PR+ tumors have the most favorable prognosis compared to the other estrogen/progesterone subtypes (ER+/PR-, ER-/PR+, ER-/PR-). Tumors with a large number of estrogen receptors are associated with a better the prognosis than those with few. Please see our article on ER+/PR+ breast cancer prognosis.

Some breast cancer risk factors are associated mainly with ER+/PR+

Late age at first period, early age at first birth, and increasing number of children have all been found to be associated with reduced risk of breast cancer, but only among those with ER+/PR+ tumors. Women with a history of migraine headaches are also less likely to develop ER+/PR+ breast cancer. Use of hormone replacement therapy (HRT), also known as menopausal hormone therapy, increases the risk of both ER+/PR+ and ER+/PR- tumors (but not ER- tumors). Women with high breast density have an increased risk for ER+/PR+ and mixed hormone receptor tumors but the association is less clear for ER-/PR- tumors. On the other hand, consumption of alcohol increases breast cancer risk for all ER/PR subtypes, as does a family history of breast cancer.

Patients with ER+/PR+ BC have opportunity to influence prognosis

There is some evidence that those with ER+/PR+ breast cancer have the greatest opportunity to improve their prognosis through diet, exercise, and by avoiding exposure to environmental estrogens. This advantage arises from the fact that this is the most hormonally driven subtype. Please see our article on what ER+/PR+ breast cancer patients and survivors should eat.

Below are links to recent studies on this topic. For a more complete list of studies, please click on ER+/PR+. See also our article on how to optimize your breast cancer diet.

Selected breast cancer studies

Stressful Life Events, Social Support, and Incident Breast Cancer by Estrogen Receptor Status Cite
Lawrence WR, McDonald JA, Williams F, Shiels MS, Freedman ND, Lin Z, et al. Stressful Life Events, Social Support, and Incident Breast Cancer by Estrogen Receptor Status. Cancer Prevention Research. American Association for Cancer Research (AACR); 2023;:OF1-OF10 10.1158/1940-6207.capr-22-0472
Racial and Ethnic Disparities in Locoregional Recurrence Among Patients With Hormone Receptor–Positive, Node-Negative Breast Cancer Cite
Kantor O, King TA, Freedman RA, Mayer EL, Chavez-MacGregor M, Korde LA, et al. Racial and Ethnic Disparities in Locoregional Recurrence Among Patients With Hormone Receptor–Positive, Node-Negative Breast Cancer. JAMA Surgery. American Medical Association (AMA); 2023; 10.1001/jamasurg.2023.0297
Conversion of ER and HER2 Status After Neoadjuvant Therapy in Chinese Breast Cancer Patients Cite
Bo J, Yu B, Bi R, Xu X, Cheng Y, Tu X, et al. Conversion of ER and HER2 Status After Neoadjuvant Therapy in Chinese Breast Cancer Patients. Clinical Breast Cancer. Elsevier BV; 2023; 10.1016/j.clbc.2023.03.002
Host-Related Factors in the Interplay among Inflammation, Immunity and Dormancy in Breast Cancer Recurrence and Prognosis: An Overview for Clinicians Cite
Ruggieri L, Moretti A, Berardi R, Cona MS, Dalu D, Villa C, et al. Host-Related Factors in the Interplay among Inflammation, Immunity and Dormancy in Breast Cancer Recurrence and Prognosis: An Overview for Clinicians. International Journal of Molecular Sciences. MDPI AG; 2023; 24:4974 10.3390/ijms24054974
Low-dose phthalates promote breast cancer stem cell properties via the oncogene Np63α and the Sonic hedgehog pathway Cite
Cao W, Zhao M, Chen Y, Zhu J, Xie C, Li X, et al. Low-dose phthalates promote breast cancer stem cell properties via the oncogene Np63α and the Sonic hedgehog pathway. Ecotoxicology and Environmental Safety. Elsevier BV; 2023; 252:114605 10.1016/j.ecoenv.2023.114605
miR-3614–5p downregulation promotes cadmium-induced breast cancer cell proliferation and metastasis by targeting TXNRD1 Cite
Yue Y, Tan M, Luo Y, Deng P, Wang H, Li J, et al. miR-3614–5p downregulation promotes cadmium-induced breast cancer cell proliferation and metastasis by targeting TXNRD1. Ecotoxicology and Environmental Safety. Elsevier BV; 2022; 247:114270 10.1016/j.ecoenv.2022.114270
Postmenopausal overweight and breast cancer risk; results from the KARMA cohort Cite
Klintman M, Rosendahl AH, Randeris B, Eriksson M, Czene K, Hall P, et al. Postmenopausal overweight and breast cancer risk; results from the KARMA cohort. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 10.1007/s10549-022-06664-7
Lifetime personal cigarette smoking and risk of young-onset breast cancer by subtype among non-Hispanic Black and White women in the Young Women's Health History Study Cite
Ihenacho U, Hamilton AS, Mack WJ, Wu AH, Unger JB, Pathak DR, et al. Lifetime personal cigarette smoking and risk of young-onset breast cancer by subtype among non-Hispanic Black and White women in the Young Women's Health History Study. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 10.1007/s10549-022-06675-4
Cigarette smoke and tumor micro-environment co-promote aggressiveness of human breast cancer cells Cite
Benoit L, Tomkiewicz C, Delit M, Khider H, Audouze K, Kowandy F, et al. Cigarette smoke and tumor micro-environment co-promote aggressiveness of human breast cancer cells. Research Square Platform LLC; 2022; 10.21203/rs.3.rs-1936680/v1
Concordance between Ki‑67 index in invasive breast cancer and molecular signatures: EndoPredict and MammaPrint Cite
Amezcua‑Gálvez J, Lopez‑Garcia C, Villarreal‑Garza C, Lopez‑Rivera V, Canavati‑Marcos M, Santuario‑Facio S, et al. Concordance between Ki‑67 index in invasive breast cancer and molecular signatures: EndoPredict and MammaPrint. Molecular and Clinical Oncology. Spandidos Publications; 2022; 17 10.3892/mco.2022.2565
Weight Gain after Hormone Receptor-Positive Breast Cancer Cite
Goyal A, Milner GE, Cimino-Mathews A, Visvanathan K, Wolff AC, Sharma D, et al. Weight Gain after Hormone Receptor-Positive Breast Cancer. Current Oncology. MDPI AG; 2022; 29:4090-4103 10.3390/curroncol29060326
Should We Completely Exclude Locoregional Therapy for the Primary Tumor from Our Clinical Practice in De Novo Metastatic Breast Cancer? Cite
Kus T, Aktas G. Should We Completely Exclude Locoregional Therapy for the Primary Tumor from Our Clinical Practice in De Novo Metastatic Breast Cancer?. Annals of Surgical Oncology. Springer Science and Business Media LLC; 2022; 10.1245/s10434-022-11979-2
Estrogen receptor positive breast cancers have patient specific hormone sensitivities and rely on progesterone receptor Cite
Scabia V, Ayyanan A, De Martino F, Agnoletto A, Battista L, Laszlo C, et al. Estrogen receptor positive breast cancers have patient specific hormone sensitivities and rely on progesterone receptor. Nature Communications. Springer Science and Business Media LLC; 2022; 13 10.1038/s41467-022-30898-0
Definition of High-Risk Early Hormone-Positive HER2−Negative Breast Cancer: A Consensus Review Cite
Garutti M, Griguolo G, Botticelli A, Buzzatti G, De Angelis C, Gerratana L, et al. Definition of High-Risk Early Hormone-Positive HER2−Negative Breast Cancer: A Consensus Review. Cancers. MDPI AG; 2022; 14:1898 10.3390/cancers14081898
Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer Cite
Ye L, Rünger D, Angarita SA, Hadaya J, Baker JL, Lee MK, et al. Higher risk tumor features are not associated with higher nodal stage in patients with estrogen receptor-positive, node-positive breast cancer. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 10.1007/s10549-022-06581-9
Impact of time to distant recurrence on breast cancer-specific mortality in hormone receptor-positive breast cancer Cite
Calip GS, Nabulsi NA, Hubbard C, Asfaw AA, Lee I, Zhou J, et al. Impact of time to distant recurrence on breast cancer-specific mortality in hormone receptor-positive breast cancer. Cancer Causes & Control. Springer Science and Business Media LLC; 2022; 10.1007/s10552-022-01561-2
Therapeutic Targeting of Minimal Residual Disease to Prevent Late Recurrence in Hormone-Receptor Positive Breast Cancer: Challenges and New Approaches Cite
Cescon DW, Kalinsky K, Parsons HA, Smith KL, Spears PA, Thomas A, et al. Therapeutic Targeting of Minimal Residual Disease to Prevent Late Recurrence in Hormone-Receptor Positive Breast Cancer: Challenges and New Approaches. Frontiers in Oncology. Frontiers Media SA; 2022; 11 10.3389/fonc.2021.667397
The Incidence of Breast Cancer Recurrence 10-32 Years after Primary Diagnosis Cite
Pedersen RN, Esen BÖ, Mellemkjær L, Christiansen P, Ejlertsen B, Lash TL, et al. The Incidence of Breast Cancer Recurrence 10-32 Years after Primary Diagnosis. JNCI: Journal of the National Cancer Institute. Oxford University Press (OUP); 2021; 10.1093/jnci/djab202
Role of estrogen receptor coregulators in endocrine resistant breast cancer Cite
Altwegg KA, Vadlamudi RK. Role of estrogen receptor coregulators in endocrine resistant breast cancer. Exploration of Targeted Anti-tumor Therapy. Open Exploration Publishing; 2021;:385-400 10.37349/etat.2021.00052
Metabolite Biomarkers of Response (BoRs): Towards a fingerprint for the evolution of metastatic breast cancer Cite
Wolf J, Dong C, O'Day EM. Metabolite Biomarkers of Response (BoRs): Towards a fingerprint for the evolution of metastatic breast cancer. Progress in Biophysics and Molecular Biology. Elsevier BV; 2021; 10.1016/j.pbiomolbio.2021.08.005

ER+/PR+ subtype has the most favorable prognosis

Some breast cancer risk factors are associated mainly with ER+/PR+

Patients with ER+/PR+ BC have opportunity to influence prognosis

Selected breast cancer studies

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