Breast Cancer Receptors: Learn What You Need to Know

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06/23/23

We teach you to about breast cancer tumor receptors and why they are important in your breast cancer treatment. Chemotherapy and hormonal therapy are based on your receptor pattern.

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Questions for your Breast Surgeon and Medical Oncologist:

1. What receptors do my tumor have?
2. What type of treatment do they suggest I will need?
3. May I have a copy of all my pathology reports?
4. Do my receptors already suggest I need chemotherapy?
5. Do my receptors show I will need hormonal therapy?
6. Would I benefit from neoadjuvant chemotherapy?

What are Breast Cancer Receptors?

Once a breast biopsy is determined to be an invasive by a pathologist under the microscope, they will automatically run at least three more tests on the same tissue to determine what “receptors” are present. Receptors are tiny proteins on the surface of the cells that act like “light switches” that can turn cancer cell growth “on” or “off.” The Estrogen receptor (ER), Progesterone receptor (PR), and HER2 receptor results are incredibly important for you to know and understand. Receptors are different than “grade” and “stage” as outlined in the diagram below. All are different pieces of the breast cancer puzzle that your physicians will assemble to determine the best therapy for you. In the case of receptors, these are key determinants as to whether you will or will not benefit from hormonal therapy (pills) or chemotherapy. The receptors involving a precancerous lesion such as DCIS have different implications and are addressed in our DCIS course.

Receptors that suggest Hormonal Therapy

Estrogen Receptor Positive (ER+) tumors are always treated with hormonal therapy. Usually these types of medications (pills) are taken for a total of 5 to 10 years. It is still possible that one may need chemotherapy in addition to hormonal therapy. If you are Progesterone Receptor Positive (PR+) then you will likely need hormonal therapy, even if you are ER-. The Estrogen Receptor plays a much more important role in cancer care than the Progesterone Receptor.

Receptors that suggest Chemotherapy

Determining if you need chemotherapy is a very complex decision process and is primarily driven by your medical oncologist. Your “receptor pattern” is a key piece of information that is known early in your breast cancer journey. In about 30% of patients with an invasive breast cancer, the receptor pattern alone can strongly suggest that chemotherapy will be needed, regardless of what is found at surgery. We list a few of the more common “chemotherapy receptor patterns” below. Many factors, including a large cancer and cancer that is present in the lymph nodes, also point someone towards chemotherapy. Take our video lesson on “Will I Need Chemotherapy“ (here). Often if someone needs chemotherapy, they will likely benefit also from hormonal therapy after chemotherapy if their estrogen receptor is positive.

Estrogen Receptor Negative (ER-) tumors do not respond to anti-estrogen oral medications that are essential for treating estrogen receptor positive (ER+) tumors. Quite simply, patients with ER negative tumors will benefit from chemotherapy if they are healthy enough to tolerate it. ER negative tumors are more aggressive cancers, but respond very well to chemotherapy. This includes “triple negative” breast cancers. Progesterone Receptors (PR) play a much smaller role than estrogen or HER2 receptors and are not addressed here.

HER2 Receptor Positive (HER2+) tumors are very responsive to chemotherapy when paired with new breakthrough drugs that target these tumors, such as Herceptin and Perjeta. The same holds true if a HER2-positive tumor is also ER positive. Take our “HER2-Positive“ video lesson to learn more (here). HER2-positive tumors are more aggressive cancers, but we now can treat them more effectively with chemotherapy and “targeted immunotherapy” drugs that are designed to destroy HER2-positive cancers.

“Triple Negative” (ER-)(PR-)(HER2-) tumors are also fast growing tumors that are usually treated with a specific chemotherapy regimen. These tumors are not responsive to hormonal therapy at all, but are sensitive to chemotherapy. If you have “Triple Negative Breast Cancer“ review our video lesson (here).

Take home message:

Make sure to ask for a copy of the pathology report from your biopsy. Ask your breast surgeon and medical oncologist to explain to you what your receptors mean regarding your treatment. Sometimes the HER2 receptor results can take up to two weeks to become finalized. Inquire early on with your physicians about your benefit from hormonal therapy and/or chemotherapy.