1. ER and PR Test Estrogen and Progesterone receptor status tests will show whether or not one or both of these hormones fuel the tumor Cancer that is hormone-sensitive is slightly slower growing and has a better chance of responding to hormone-suppression treatment

2. ER and PR Test ER(+) – Estrogen is causing the tumor to grow – Cancer should respond well to hormone suppression treatments ER(-) – Tumor is not driven by estrogen – Results will need to be evaluated along with other tests such as HER2 status

3. ER and PR Test PR(+) – Cancer should respond well to hormone suppression treatments PR(-) – Tumor is not driven by progesterone – Another test is needed such as HER2 status

4. Metastatic Work-ups Staging Investigations in Patients With Breast Cancer (The Role of Bone Scans and Liver Imaging) – Rajiv Samant, MD; Pradip Ganguly, MD The goal of these tests is to identify those patients with incurable disease so that a more realistic prognosis can be given and their treatment can be tailored accordingly – Isotopic bone scans – Isotopic liver scans or liver ultrasound

5. Metastatic Work-ups Staging Investigations in Patients With Breast Cancer (The Role of Bone Scans and Liver Imaging) – Rajiv Samant, MD; Pradip Ganguly, MD Conclusion – Our results confirm the low yield of routine bone scans and liver imaging among patients with asymptomatic, pathologically confirmed, early stage (T1-2 N0-1) breast cancer. Therefore, we do not recommend these tests for such patients, although intensive investigations are appropriate for more advanced (stage T3-4 or N2) tumors.

6. RADIOTHERAPY/TAMOXIFEN IF ER+ PLAN:

7. Radiation Therapy Uses high levels of radiation to kill cancer cells or keep them from growing and dividing -- while minimizing damage to healthy cells May be used for all stages of breast cancer Adjuvant therapy to reduce the risk of local recurrence to the chest wall and supraclavicular lymph nodes

8. Anti-estrogen Therapy Adjuvant therapy with tamoxifen (Early Breast Cancer Trialists’ Collaborative Group) – 25% reduction in the annual risk of breast cancer recurrence – 7% reduction in annual breast cancer mortality – 39% reduction in the risk of cancer in the contralateral breast Advantage over chemotherapy: absence of severe toxicity

9. References Hormone Receptor Status and Diagnosis - Estogen and Progesterone by Pam Stephan; http://breastcancer.about.com/od/diagnosis/p/hormo ne_status.htm http://breastcancer.about.com/od/diagnosis/p/hormo ne_status.htm Samant, R., Ganguly, P. 1999. Staging Investigations in Patients With Breast Cancer (The Role of Bone Scans and Liver Imaging). ARCH SURG/VOL 134. Breast Cancer: Radiation Therapy: What to Expect;http://www.medicinenet.com/radiation_therap y_for_breast_cancer/article.htmhttp://www.medicinenet.com/radiation_therap y_for_breast_cancer/article.htm Schwartz’s Manual of Surgery