Hormone receptor positive (ER+/PR+) breast cancer prognosis

Last updated: June 12, 2024

Drivers of ER+/PR+ breast cancer progression

Hormone receptor positive breast cancer has both estrogen receptor positive (ER+) and progesterone receptor positive (PR+) tumor receptors. Systemic treatments for ER+/PR+ tumors for the most part regulate ER expression, oppose aromatase or inhibit estrogen binding to estrogen receptors. See also ER+/PR+ recurrence & survival data.

Breast cancer patients with ER+/PR+ tumors have a more favorable prognosis than the other estrogen/progesterone subtypes (ER+/PR-, ER-/PR+, or ER-/PR-). Tumor properties, such as their grade and size, lymph node status and proliferation index, have been demonstrated to influence outcomes. These prognostic factors are established as of diagnosis and biopsy.

However, most early-stage breast cancer patients have the opportunity to influence their prognosis over time with lifestyle choices. And since this is the most hormonally driven subtype, ER+/PR+ breast cancer survivors have the greatest opportunity to influence their outcomes with choices that can influence estrogen and other hormone levels directly or indirectly.

Non-dietary factors promoting ER+/PR+ progression

The following have the potential to promote ER+/PR+ breast cancer progression:

Lack of exercise
Obesity
Type 2 diabetes
High cholesterol
High blood pressure
High systemic inflammation
Lack of endocrine treatment
Exposure to endocrine disruptors such as BPA, phthalates, and parabens
Exposure to certain heavy metals such as cadmium, copper or arsenic
Smoking cigarettes or e-cigarettes
Persistent exposure to light at night
Occupational exposure to radiation
Exposure to significant air pollution

The factors above are not presented in order of importance. For articles and news stories concerning dietary factors that influence ER+/PR+ progression, please click on the tab metastasis.

Sources of information provided in this webpage

The information above, which is updated continually as new research becomes available, has been developed based solely on the results of academic studies. Clicking on any of the underlined words will take you to its tag or webpage, which contain more extensive information.

Below are links to recent studies concerning this topic. For a more complete list of studies, please click on ER+/PR+. Please also see our articles on ER+/PR+ recurrence & survival data, hormone receptor positive breast cancer (which describes ER+/PR+ disease) and diet for ER+/PR+ breast cancer patients and survivors.

Selected breast cancer studies

Clinical and molecular predictors of very late recurrence in oestrogen receptor-positive breast cancer patients Cite
Richman J, Schuster G, Buus R, Lopez-Knowles E, Dowsett M. Clinical and molecular predictors of very late recurrence in oestrogen receptor-positive breast cancer patients. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2024; 10.1007/s10549-024-07311-z
Impact of neoadjuvant compared to adjuvant chemotherapy on prognosis in patients with hormone-receptor positive / HER2-negative breast cancer: a propensity score matching population-based study Cite
Hosseini-Mellner S, Wickberg Å, Karakatsanis A, Valachis A. Impact of neoadjuvant compared to adjuvant chemotherapy on prognosis in patients with hormone-receptor positive / HER2-negative breast cancer: a propensity score matching population-based study. The Breast. Elsevier BV; 2024;:103741 10.1016/j.breast.2024.103741
First-line real-world treatment patterns and survival outcomes in women younger or older than 40 years with metastatic breast cancer in the real-life multicenter French ESME cohort Cite
Galvin A, Courtinard C, Bouteiller F, Gourgou S, Dalenc F, Jacot W, et al. First-line real-world treatment patterns and survival outcomes in women younger or older than 40 years with metastatic breast cancer in the real-life multicenter French ESME cohort. European Journal of Cancer. Elsevier BV; 2024; 196:113422 10.1016/j.ejca.2023.113422
Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study Cite
Hung S, Yang H, Lee M, Liu D, Chen L, Chew C, et al. Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study. Breast Cancer Research. Springer Science and Business Media LLC; 2023; 25 10.1186/s13058-023-01747-9
The prognostic and predictive effect of body mass index in hormone receptor-positive breast cancer Cite
Lammers SWM, Geurts SME, Van Hellemond IEG, Swinkels ACP, Smorenburg CH, Van Der Sangen MJC, et al. The prognostic and predictive effect of body mass index in hormone receptor-positive breast cancer. JNCI Cancer Spectrum. Oxford University Press (OUP); 2023; 10.1093/jncics/pkad092
Trends in the Incidence and Survival of Women with Hormone Receptor-Positive Breast Cancer from 1990–2019: A Large Population-Based Analysis Cite
Huang Hb, Wei T, Zhang A, Zhang H, Kong L, Li Y, et al. Trends in the Incidence and Survival of Women with Hormone Receptor-Positive Breast Cancer from 1990–2019: A Large Population-Based Analysis. Research Square Platform LLC; 2023; 10.21203/rs.3.rs-3569419/v1
Breast cancer mortality in 500 000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study Cite
Taylor C, McGale P, Probert J, Broggio J, Charman J, Darby SC, et al. Breast cancer mortality in 500 000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study. BMJ. BMJ; 2023;:e074684 10.1136/bmj-2022-074684
Postoperative Adjuvant Anastrozole for 10 or 5 Years in Patients With Hormone Receptor–Positive Breast Cancer: AERAS, a Randomized Multicenter Open-Label Phase III Trial Cite
Iwase T, Saji S, Iijima K, Higaki K, Ohtani S, Sato Y, et al. Postoperative Adjuvant Anastrozole for 10 or 5 Years in Patients With Hormone Receptor–Positive Breast Cancer: AERAS, a Randomized Multicenter Open-Label Phase III Trial. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2023; 10.1200/jco.22.00577
The clinical value of progesterone receptor expression in luminal breast cancer: A study of a large cohort with long‐term follow‐up Cite
Lashen AG, Toss MS, Mongan NP, Green AR, Rakha EA. The clinical value of progesterone receptor expression in luminal breast cancer: A study of a large cohort with long‐term follow‐up. Cancer. Wiley; 2023; 10.1002/cncr.34655
Long-term treatment patterns and survival in metastatic breast cancer by intrinsic subtypes – an observational cohort study in Sweden Cite
Lindman H, Wiklund F, Andersen KK. Long-term treatment patterns and survival in metastatic breast cancer by intrinsic subtypes – an observational cohort study in Sweden. BMC Cancer. Springer Science and Business Media LLC; 2022; 22 10.1186/s12885-022-10098-1
Estimating long-term mortality in women with hormone receptor-positive breast cancer: The ‘ESTIMATE’ tool Cite
Leone JP, Graham N, Tolaney SM, Leone BA, Freedman RA, Hassett MJ, et al. Estimating long-term mortality in women with hormone receptor-positive breast cancer: The ‘ESTIMATE’ tool. European Journal of Cancer. Elsevier BV; 2022; 173:20-29 10.1016/j.ejca.2022.06.029
Abstract P3-18-03: Long-term outcomes for breast conservation plus radiotherapy versus mastectomy in early breast cancer after neoadjuvant systemic therapy: Results from the Swedish national breast cancer register (NKBC) Cite
Wang K, Duinmeijer A, Matikas A, Altena R, Johansson H, Fredholm H, et al. Abstract P3-18-03: Long-term outcomes for breast conservation plus radiotherapy versus mastectomy in early breast cancer after neoadjuvant systemic therapy: Results from the Swedish national breast cancer register (NKBC). Cancer Research. American Association for Cancer Research (AACR); 2022; 82:P3-18-03-P3-18-03 10.1158/1538-7445.sabcs21-p3-18-03
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
Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics Cite
Nelson DR, Brown J, Morikawa A, Method M. Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics. PLOS ONE. Public Library of Science (PLoS); 2022; 17:e0264637 10.1371/journal.pone.0264637
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
Extended therapy with letrozole as adjuvant treatment of postmenopausal patients with early-stage breast cancer: a multicentre, open-label, randomised, phase 3 trial Cite
Del Mastro L, Mansutti M, Bisagni G, Ponzone R, Durando A, Amaducci L, et al. Extended therapy with letrozole as adjuvant treatment of postmenopausal patients with early-stage breast cancer: a multicentre, open-label, randomised, phase 3 trial. The Lancet Oncology. Elsevier BV; 2021; 10.1016/s1470-2045(21)00352-1
Risk evaluation of early-stage hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer patients: a population-based study from Taiwan Cite
Lei L, Chan H, Lu T, Cheng SH. Risk evaluation of early-stage hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer patients: a population-based study from Taiwan. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2021; 10.1007/s10549-021-06330-4
Luminal Breast Cancer: Risk of Recurrence and Tumor-Associated Immune Suppression Cite
Pellegrino B, Hlavata Z, Migali C, De Silva P, Aiello M, Willard-Gallo K, et al. Luminal Breast Cancer: Risk of Recurrence and Tumor-Associated Immune Suppression. Molecular Diagnosis & Therapy. Springer Science and Business Media LLC; 2021; 10.1007/s40291-021-00525-7
6P 25-year survival and benefit from tamoxifen therapy by the clinically used breast cancer markers in lymph node-negative and ER-positive/HER2-negative breast cancer Cite
Dar H, Johansson A, Nordensköljd A, Iftimi A, Yau C, Perez-Tenorio G, et al. 6P 25-year survival and benefit from tamoxifen therapy by the clinically used breast cancer markers in lymph node-negative and ER-positive/HER2-negative breast cancer. Annals of Oncology. Elsevier BV; 2021; 32:S23 10.1016/j.annonc.2021.03.020
Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomised, phase 3 trial Cite
Smith I, Robertson J, Kilburn L, Wilcox M, Evans A, Holcombe C, et al. Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomised, phase 3 trial. The Lancet Oncology. Elsevier BV; 2020; 21:1443-1454 10.1016/s1470-2045(20)30458-7

Non-dietary factors promoting ER+/PR+ progression

Sources of information provided in this webpage

Selected breast cancer studies

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