Hormone receptor positive, HER2 negative breast cancer

What hormone receptor positive breast cancer is

Most breast cancers are this type. The cells carry estrogen receptors, progesterone receptors, or both, which means estrogen in the body helps them grow. That is a weakness that can be used: medicines that block estrogen or lower it starve the cancer, and they work for years after surgery to keep it from coming back. A report is called ER positive when at least 1 in 100 cancer cells stains for the receptor; between 1 and 10 it may be called ER low positive, which is treated a little differently.

What usually happens next with hormone receptor positive breast cancer, in order

1. Surgery first, usually. A lumpectomy or a mastectomy, with a sentinel node biopsy to check the first few lymph nodes. For larger cancers where a lumpectomy would be difficult, several months of an anti-estrogen pill before surgery can shrink the cancer enough to allow one.
2. The final report. The actual size, the margins, and the nodes set the final stage. For invasive cancer, a margin is clear when there is no cancer at the inked edge of the tissue.
3. A test to decide about chemotherapy. For many people with this type, especially when the nodes are clear, a test such as Oncotype DX is run on the tumor. It looks at the activity of 21 genes and gives a score that predicts whether chemotherapy would add anything to the anti-estrogen pill. For a large share of people the answer is that it would not, and they never have chemotherapy.
4. Radiation, after a lumpectomy, and after a mastectomy when the cancer was large or several nodes were involved.
5. Endocrine therapy. A daily pill for five years, often extended to seven to ten. Before menopause it is usually tamoxifen, sometimes with medicine that switches the ovaries off. After menopause it is usually an aromatase inhibitor. For higher-risk cancers, a newer pill called a CDK4/6 inhibitor may be added for the first two to three years.

Choices you will be asked about with hormone receptor positive breast cancer

Lumpectomy or mastectomy. Whether to have chemotherapy if the score is in the middle range. Which endocrine pill, which depends partly on side effects. Whether to add ovarian suppression before menopause, which is a trade between a lower chance of recurrence and menopause symptoms arriving early. If a mastectomy, reconstruction and its timing.

Questions to bring to your appointment

These are built for hormone receptor positive breast cancer. The report decoder narrows the list further from your own report, and the print button there puts it on paper with room to write. Bring someone with you if you can; two sets of ears hear more than one.

• What is the exact type, grade, and receptor status, and can I have a copy of the report?
• What stage is it now, and what could change that after surgery?
• Should surgery come first, or medicine first, and why?
• Am I a candidate for a lumpectomy? If I chose mastectomy instead, would the outcome differ?
• How will the lymph nodes be checked, and what happens if one is positive?
• Which anti-estrogen medicine, for how long, and what side effects should I expect?
• Will a test such as Oncotype DX be run to decide about chemotherapy?
• Do I qualify for genetic testing, and should it be done before I decide on surgery?
• Do I need any scans of the rest of my body, and if not, why not?
• If I want to talk to a plastic surgeon before deciding, can that happen first?
• Is there a clinical trial I should know about?
• How much time do I have to decide? Is there anything that must be decided today?
• Who is my contact between appointments, and how do I reach them?
• Is there a nurse navigator or counselor I can be connected with?

Where this comes from

Published 7 September 2026 as part of the guide; a page of its own since 9 September 2026.