ArticleThe Lancet regional health. Europe2026
Patient characteristics, treatment patterns, and survival across estrogen receptor expression subgroups in HER2-negative breast cancer: a population-based cohort study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Estrogen receptor (ER) low (1-9%) breast cancer (BC) often behaves like triple-negative BC, while ERhigh (≥60%) disease has a more favorable prognosis. However, tumors with ER expressing 10-59% represent a poorly defined patient population. In this nationwide cohort study, we aimed to describe real-world patient characteristics, treatment patterns and survival across the entire ER spectrum in Human Epidermal growth factor Receptor 2 (HER2)-negative BC. Methods: We conducted a population-based cohort study of all women diagnosed with HER2-negative BC in Sweden (2007-2023), based on prospectively collected data. Tumors were stratified into five ER subgroups: ER Findings: We included 75,211 patients. Compared to the ERhigh subgroup, both the ERmild (adjusted HR [aHR] = 1.59, 95% confidence interval [CI]: 1.31-1.93) and ERmod (aHR = 1.31, 95% CI: 1.17-1.47) subgroups had significantly worse survival (both adjusted P [aP] < 0.001). Notably, ERmild patients had survival outcomes and molecular characteristics similar to those of ERlow and ERzero patients. Patients with ERmild (aHR = 0.46, 95% CI: 0.23-0.94, aP = 0.033) and ERmod (aHR = 0.60, 95% CI: 0.42-0.85, aP = 0.0046) tumors, CT + ET was associated with a lower risk of death than ETonly. Interpretation: Our findings highlight the importance of assessment of ER-low, mild and moderate tumors (1-59%). Reporting ER as a percentage can provide additional biological insight in clinical decision-making. Funding: This study received no external funding.
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