The hormone receptor status of an invasive breast carcinoma may predict response to endocrine therapy. Different thresholds are currently being discussed to categorise a tumour as hormone receptor positive and to recommend endocrine therapy to those patients.

The aim of this question was to determine which is the most appropriate threshold to use.

Healthcare question

Should a threshold of 10% or more vs. 1% or more of cells showing oestrogen receptor positivity be used for providing endocrine therapy in women with invasive breast cancer?


In women with invasive breast cancer, the ECIBC's Guidelines Development Group (GDG) suggests administration of adjuvant endocrine therapy if 1% or greater of tumour cells show oestrogen receptor positivity rather than applying a threshold of 10% tumour cell oestrogen receptor positivity.

Recommendation strength ­

  Conditional recommendation against the intervention

  Very low certainty of the evidence

Considerations for implementation and policy making

The comparison is already current practice, therefore no implementation considerations were identified.

Research priorities

  1. New research using ideally modern oestrogen receptor (ER) immunohistochemical techniques on tumour tissue primarily fixed in 10% neutral buffered formalin.
  2. The GDG suggested additional observational studies to provide evidence on the current threshold used in practice, ideally using modern immunohistochemical techniques.

Monitoring and evaluation

The GDG suggested monitoring low (1-9%) and high (10% and above) ER positivity in relation to patient outcomes to better assess ER thresholds for treatment.

Supporting documents