Oestrogen receptor status: no longer an optional extra

One hundred consecutive patients with primary, operable invasive breast cancer were studied to determine if the presence of oestrogen receptor (ER) status altered the decision regarding prescription of adjuvant systemic therapy. Following a 4-month period, the histopathology of 100 cases was reviewed but the ER status of each patient was blinded. A new consensus plan for systemic therapy was produced for each patient and compared with the original treatment plan decided on the basis of all prognostic factors including ER status. Despite the absence of ER status, it was possible to predict the correct adjuvant therapy in a high percentage of patients aged over 69 years (18 of 20), good-prognosis postmenopausal patients (14 of 14) and patients eligible for the BASO 11 study (11 of 12). In the remaining patients, the absence of ER status resulted in different recommendations in 31 of 54 patients (57%). Lack of ER status led to more patients being offered trials of adjuvant chemotherapy, with no premenopausal patients considered for trials of ovarian ablation.