ER-positive PR-positive HER2-negative breast cancer cells have both hormone receptors but don’t overexpress HER2. There are several treatments for this type of breast cancer, including surgery and hormone therapy.

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Breast cancer is the most common type of cancer in females. The American Cancer Society estimates that 310,720 females in the United States will receive a breast cancer diagnosis in 2024.

Breast cancer has different subtypes based on markers found on the cancer cells:

  • Hormone receptors (HRs) include those for estrogen (ER) and progesterone (PR). These two hormones can attach to HRs and promote the growth of cancer.
  • HER2 is another receptor that can be overexpressed on the surface of breast cancer cells. Too much HER2 can also boost the growth of cancer.

According to the National Cancer Institute Surveillance, Epidemiology, and End Results Program, 70% of females who received a breast cancer diagnosis in the years 2017 through 2021 had an HR-positive HER2-negative subtype.

Language matters

You’ll notice we use the binary term “female” in this article. While we realize this term may not match your gender experience, this is the term used by the researchers whose data was cited. We try to be as specific as possible when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data for or may not have had participants who are transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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When planning treatment for ER-positive PR-positive HER2-negative breast cancer, one consideration is the extent of the cancer.

When the cancer is still localized to your breast or has spread regionally, the goal can be to eliminate the cancer and prevent it from coming back.

If the cancer has spread to more distant tissues (metastasized), the goal of treatment can shift to shrinking the cancer, preventing it from spreading further, and reducing cancer symptoms.

Other considerations may include the intent of therapy (curative or palliative), your age and overall health, and your personal goals for treatment.

There are many treatment options for ER-positive PR-positive HER2-negative breast cancer, including:

  • surgery
  • hormone therapy
  • radiation therapy
  • targeted therapy
  • chemotherapy

We’ll discuss each type of treatment in a little more detail below.

Many breast cancers are first treated with surgery to remove the cancer. For some early stage breast cancers, surgery can remove the cancer completely.

There are two types of surgery for breast cancer:

  • A lumpectomy, or breast-conserving surgery, involves removing just the cancer and some of the surrounding tissue.
  • A mastectomy involves removing your whole breast and, often, the lymph nodes under your arm.

The type of surgery you have can depend on the size, location, and number of tumors. Your age, overall health, and personal preference also play a role.

One of the main side effects of surgery is pain. Other potential side effects include infections, bleeding, and neck or shoulder pain. If lymph nodes are removed from your underarm during surgery, you may develop lymphedema.

Hormone therapy is one of the main treatments for breast cancers that are HR-positive. Many people receive hormone therapy for at least 5 years.

Hormone therapy works by blocking hormones from binding to HRs or by reducing hormone production in your body, thus reducing the growth of the cancer. Most hormone therapy drugs target the activity of estrogen. Examples include:

Hormone therapy may be used:

  • before surgery to help shrink a tumor
  • after surgery to help kill the remaining cancer cells
  • as a main part of treatment for breast cancer that has spread or in people who cannot have surgery or choose not to have it

Common side effects of hormone therapy include night sweats, hot flashes, and vaginal dryness. If you haven’t yet entered menopause, hormone therapy can also disrupt your menstrual cycle.

More serious possible side effects depend on the drug used but may include bone loss, mood changes, and a higher risk of blood clots.

Radiation therapy harnesses high energy radiation to destroy cancer cells. It’s typically used:

  • after surgery to help kill the remaining cancer cells
  • as a main part of treatment for breast cancer that has spread or in people who cannot have surgery or choose not to have it
  • to help ease symptoms or prevent complications in people with metastatic breast cancer

There are two main types of radiation therapy for breast cancer:

  • external beam radiation therapy, during which a machine outside of your body delivers the radiation
  • brachytherapy, in which a device containing a small amount of radiation is placed inside your body near the location of the cancer

Skin reactions such as peeling, redness, and tenderness are common side effects of radiation therapy. Additional side effects can include fatigue, breast swelling, and damage to fatty breast tissue.

Targeted therapy drugs focus on specific markers found on breast cancer cells. While many targeted therapy drugs target HER2, some can also be used for ER-positive PR-positive HER2-negative breast cancer, including:

  • CDK4/6 inhibitors such as palbocicbib (Ibrance) and ribociclib (Kisqali)
  • the mTOR inhibitor everolimus (Afinitor)
  • the PI3K inhibitor alpelisib (Piqray)
  • the AKT capivasertib (Truqap)
  • the antibody-chemotherapy drug conjugate sacituzumab govitecan (Trodelvy)
  • the drugs olaparib (Lynparza) and talazoparib (Talzenna), in people with BRCA mutations

Targeted therapy drugs can be an option after surgery to kill the remaining cancer cells. They can also be used as the main form of treatment in people who cannot have surgery or choose not to have it.

The side effects of targeted therapy drugs depend on the specific drug used. Common side effects include fatigue, nausea or vomiting, and low blood counts.

Chemotherapy involves drugs that target the growth and division of cancer cells, slowing their growth or killing them outright. It may be given:

  • before surgery to help shrink a tumor (neoadjuvant chemotherapy)
  • after surgery to help kill the remaining cancer cells (adjuvant chemotherapy)
  • as a main part of treatment for breast cancer that has spread or in people who cannot have surgery or choose not to have it

There are a variety of chemotherapy drugs that you might receive, depending on whether the chemotherapy is being used before or after surgery or for metastatic breast cancer.

Chemotherapy can also affect healthy cells that grow and divide quickly. Because of this, it can cause side effects such as:

Alternative treatments are those used in place of conventional treatments. There are currently no alternative treatments that can cure ER-positive PR-positive HER2-negative breast cancer.

However, some alternative treatments can be used alongside conventional therapies to manage cancer symptoms and treatment side effects and improve quality of life. This is called complementary medicine.

According to the National Center for Complementary and Integrative Health, complementary approaches that may be beneficial for people with cancer include:

If you’re interested in using complementary treatments alongside your breast cancer treatment, talk with your doctor beforehand. They can help you get started and let you know about potential risks.

If you’ve received a diagnosis of ER-positive PR-positive HER2-negative breast cancer, it’s perfectly normal to have many questions about your cancer and its treatment.

Treatment-related questions that you might want to ask your care team include:

  • What treatment (or treatments) is being recommended and why?
  • What are the goals of my treatment?
  • Are there any alternatives to this treatment? If so, how would they affect my outlook?
  • When will my treatment start?
  • How long will I receive treatment?
  • Where will I receive treatment?
  • What side effects can I expect from my treatment? What steps can I take to prevent or reduce them?
  • When should I call you about treatment side effects? When should I go to the emergency room?
  • Are there any lasting effects associated with this treatment?
  • How will treatment be different if my cancer comes back?

Where to find support if you’re having treatment for ER-positive PR-positive HER2-negative breast cancer

If you’re starting treatment for ER-positive PR-positive HER2-negative breast cancer, there are resources available to help you find support.

The American Cancer Society (ACS) offers a 24/7 Cancer Helpline, help with transportation and lodging during treatment, and affordable mastectomy and hair loss products. The ACS Cancer Survivors Network can also connect you with other people who have breast cancer.

In addition to providing a wealth of information about breast cancer, the Susan G. Komen Foundation offers a financial assistance program to help with the costs of breast cancer treatment.

Living Beyond Breast Cancer offers three private support groups on social media and funding for people with breast cancer who need additional financial support.

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The outlook for ER-positive PR-positive HER2-negative breast cancer can depend on several factors, including:

  • the stage of your cancer
  • the grade of your cancer, which is a measure of how likely it is to grow and spread quickly
  • the genetic characteristics of your cancer
  • how your cancer responds to the recommended treatment
  • your age and overall health

If you’ve recently received a diagnosis of ER-positive PR-positive HER2-negative breast cancer, ask your care team about your outlook. They can consider the factors above to give you a better idea of your outlook.

What’s the first-line treatment for ER-positive PR-positive HER2-negative breast cancer?

The first-line treatment for ER-positive PR-positive HER2-negative breast cancer is often surgery and hormone therapy with or without radiation therapy. If you don’t undergo surgery, you might receive hormone therapy, sometimes in combination with a targeted therapy drug.

The treatment method you receive will depend on the size and stage of the cancer, but this is the most common treatment for earlier stages.

What is the life expectancy of ER-positive PR-positive HER2-negative breast cancer?

According to the National Cancer Institute, the 5-year survival rates for HR-positive HER2-negative breast cancer are:

  • close to 100% when the cancer is localized to your breast
  • 90.5% when the cancer has spread to nearby tissues or lymph nodes
  • 35.4% when the cancer has metastasized
  • 95.1% overall

Is it better to have ER-positive and PR-positive breast cancer?

Generally speaking, yes. Some research suggests that breast cancer that’s both ER-positive and PR-positive has a better outlook than other types.

How aggressive is HER2-negative breast cancer?

The outlook for HER2-negative breast cancer depends on its hormone receptor (HR) status. HER2-negative breast cancer that’s HR-positive has a better outlook than HER2-negative breast cancer that’s HR-negative (also called triple-negative breast cancer).

ER-positive PR-positive HER2-negative breast cancer has hormone receptors for both estrogen and progesterone and is negative for overexpression of HER2. Several treatments are available for this type of breast cancer.

Surgery and hormone therapy with or without radiation therapy is a common treatment used for ER-positive PR-positive HER2-negative breast cancer.

If you cannot have surgery or choose not to have it, treatment can often involve one or a combination of systemic treatments such as hormone therapy, targeted therapy, and chemotherapy.

The outlook for this type of breast cancer is generally good, especially if it’s found early. Be sure to have an open conversation with your care team to get an idea of your individual outlook.