Estrogen Receptor and Progesterone Receptor Test
- Also Known As:
- Hormone Receptor Test
- ER/PR Test
- Hormone Receptor Status Test
- ER/PR IHC Test
- Formal Name:
- Estrogen Receptor and Progesterone Receptor Test
Test Quick Guide
Estrogen and progesterone are hormones involved in many bodily processes including reproduction and female sexual development. Cells that use estrogen or progesterone first have to bind to the hormones through receptors on the cell surface. These are known as estrogen receptors (ER) and progesterone receptors (PR).
Many breast cancer cells have estrogen and progesterone receptors and use these hormones to fuel their growth.
ER/PR testing is done using a sample of tissue taken during a biopsy. This same tissue sample is also used to diagnose cancer. The results of an ER/PR test help doctors plan treatment and understand how likely the cancer is to grow or spread.
About the Test
Purpose of the test
The purpose of estrogen receptor (ER) and progesterone receptor (PR) testing is to assess how a cancer grows.
Testing determines whether breast cancer cells have special proteins called receptors that can bind to the hormones estrogen or progesterone.
The result of the test determines the cancer’s ER/PR status. Cancers with estrogen receptors are referred to as estrogen receptor-positive or ER-positive. Breast cancers with progesterone receptors are referred to as progesterone receptor-positive or PR-positive.
Testing is usually done at the same time that a tissue sample is analyzed for the presence of cancer. If cancer is found, an ER/PR test can assess whether the cancer can use estrogen and progesterone to grow.
Knowing the ER/PR status of a tumor can help a doctor understand a patient’s prognosis, which is the most likely course of the disease, including the risk of the cancer coming back after treatment. ER/PR testing is also used for treatment planning because it can help determine if a patient may benefit from a type of treatment called hormone therapy.
What does the test measure?
Estrogen and progesterone receptor testing measures the percentage of breast cancer cells that have estrogen or progesterone receptors.
In many tissues of the body, it is normal to have estrogen and progesterone receptors on the surface of cells. These receptors allow certain cells to use hormones to carry out typical bodily processes. For example, these receptors are found in the tissues of the reproductive tract of females or anyone with a cervix. Estrogen and progesterone receptors are also typically found on other cells in the body, including in the breast tissue of people of any sex.
However, estrogen and progesterone receptors can also contribute to the growth of cancer cells. Breast cancer tissue with estrogen and progesterone receptors may use these hormones to grow more quickly.
When should I get an estrogen and progesterone receptor test?
Testing for ER/PR status is commonly performed as part of testing for breast cancer. This testing is conducted because most breast cancers have estrogen and/or progesterone receptors.
ER/PR testing is most frequently used in the following situations:
- In patients with newly diagnosed breast cancer: In these cases, the same biopsy sample used to diagnose the cancer is also used for ER/PR testing.
- In patients with breast cancer that has spread from the breast to other parts of the body, called metastatic breast cancer: ER/PR testing for metastatic breast cancer may require biopsy samples from one or more locations where the cancer has spread.
- In patients with breast cancer that has come back after treatment, also called recurrent cancer: This testing requires a new biopsy from the part of the body where the cancer has returned.
Estrogen receptor testing is also recommended for patients with ductal carcinoma in situ (DCIS), which is when abnormal cells are found in the lining of a breast duct. Testing for progesterone receptor status is considered optional for DCIS patients.
If you have been diagnosed with DCIS or breast cancer, it may be helpful to speak with your doctor about hormone receptor testing in your specific situation.
Finding an Estrogen and Progesterone Receptor Test
How to get tested
ER/PR testing is performed on a tissue sample taken during a biopsy. A biopsy is a procedure to remove cells or tissue from the body, and it is used to diagnose cancer and to determine ER/PR status.
The biopsy sample is analyzed in a laboratory by a specialist known as a pathologist. ER/PR testing is ordered by a doctor, and the biopsy is normally performed in a hospital or medical office.
Can I take the test at home?
There is no at-home test to determine a breast cancer patient’s ER/PR status. Testing for ER/PR status must be performed on a tissue sample sent to a laboratory, and biopsies to obtain the sample must be done in a medical setting.
How much does the test cost?
There are a number of factors that may impact the cost of testing for estrogen and progesterone receptor status. Costs vary based on insurance coverage and insurance-related costs like copays and deductibles. The type of biopsy you receive and laboratory and professional fees for the pathologist can also impact the cost of testing.
Talking with your doctor or insurance provider about the costs of ER/PR testing may be helpful. They may be able to provide more information about possible out-of-pocket costs for the biopsy and tissue analysis.
Taking an Estrogen and Progesterone Receptor Test
A sample of tissue taken during a biopsy is needed to test for ER/PR status. There are different types of biopsies including a needle biopsy and surgical biopsy. A needle biopsy removes fluid and tissue through a needle, whereas a surgical biopsy removes part or all of a lump. Your doctor can provide information about what type of biopsy is best for your situation.
Before the test
Your doctor will provide information about what type of biopsy you need. They will also provide information about any steps needed to prepare for your procedure. If you will be given a local anesthetic, there may be no special test preparation.
If your doctor is suggesting a surgical biopsy, you will need a sedative or general anesthesia for the procedure. Your doctor may ask you not to eat or drink for several hours before your biopsy. You will also need to arrange for someone to drive you home following the procedure.
It is important to speak with your doctor about how to prepare for the specific type of biopsy that they are recommending.
During the test
What to expect during the test will depend on the kind of biopsy that you are having.
Most biopsies involve an anesthetic to reduce pain. The anesthetic can be local or general. If you are given a local anesthetic, you may experience some pressure while the test is performed. However, you do not usually experience pain.
If you are having a biopsy that requires general anesthesia, you will be unconscious during the procedure and should not feel pressure or pain.
After the test
After a needle biopsy, pressure is applied to the biopsy site to help stop any bleeding. The area will be covered with a sterile bandage.
If you are having a surgical biopsy, the area where the tissue sample was removed will be closed with adhesive strips or stitches.
If you receive anesthesia or a sedative before your biopsy procedure, you may experience confusion or feelings of grogginess after waking. You may need to stay at the medical facility for observation, and you may be given instructions for recovering at home. Someone else will need to drive you home after your procedure.
In most cases, you will recover quickly and without serious complications after a biopsy. However, if you notice ongoing bleeding or signs of an infection, you should contact your health care provider promptly.
Estrogen and Progesterone Receptor Test Results
Receiving test results
Results of estrogen and progesterone receptor testing will be included on your pathology report. Your doctor will usually receive the pathology report within 10 days of your biopsy.
Your doctor may contact you to speak with you about your biopsy results. Your report may also be posted to an online health portal or sent to you in the mail.
Interpreting test results
Your pathology report will include basic information that describes the tissue that was removed during your biopsy procedure and your diagnosis. The results of additional testing performed on the tissue sample, such as ER/PR testing, will also be included on your report.
Immunohistochemistry (IHC) is the most common method used for testing a sample of tissue for estrogen and progesterone receptors. The results of IHC testing for ER/PR status are reported as follows:
- ER/PR-positive: 1% to 100% of tumor cells examined have receptors
- ER/PR-negative: less that 1% of tumor cells examined have receptors
An ER/PR-positive tumor uses estrogen and/or progesterone to grow. An ER/PR-negative tumor does not use either of these hormones. Different laboratories methods can be used to assess how much the tumor takes up estrogen or progesterone.
Other terms may be used to describe the results of an ER/PR test. Breast cancers that have estrogen and/or progesterone receptors may be called hormone-sensitive, hormone receptor-positive, or HR-positive. Cancers that do not use hormones to grow are referred to as hormone insensitive, hormone receptor-negative, or HR-negative.
ER/PR status is one of many factors that a doctor will consider after a diagnosis of breast cancer. The prognosis and treatment are also affected by the size and location of a tumor, whether it has spread to other parts of the body, whether it uses another protein called HER2 to grow, and your overall health.
Breast cancers that are hormone sensitive may grow more quickly. However, ER/PR-positive cancer may respond to treatment with hormone therapy, which is designed to cut off the cancer’s ability to use hormones to grow. Breast cancer that is ER/PR-negative will not be affected by hormone therapy.
Are test results accurate?
Estrogen and progesterone receptor testing is commonly performed as part of the diagnostic process for people who have breast cancer. Recommendations and guidelines exist to improve accuracy, but like any medical test, ER/PR testing isn’t 100% accurate.
Individual laboratories or pathologists may interpret the ER/PR test differently, and that interpretation may depend on the size and number of tissue samples.
You can speak with your doctor if you have questions about the results of your biopsy or the accuracy of estrogen or progesterone receptor testing in your case.
Do I need follow-up tests?
There are no standard follow-up tests needed for patients who undergo ER/PR testing.
As treatment for your breast cancer starts, your doctor may talk with you about a plan to monitor your response to treatment. You can ask your doctor about what tests and/or follow-up may be best for your diagnosis.
Questions for your doctor about test results
The following questions may be helpful to ask your doctor to learn more about your ER/PR test results and what they mean for your cancer care:
- What are the results of my ER/PR test? Am I hormone receptor-positive or hormone receptor-negative?
- What does the result of my test mean for my prognosis?
- How does my test result impact my treatment plan?
- Am I a candidate for hormone therapy?
Estrogen and progesterone receptor testing vs. HER2 testing
Like ER/PR testing, HER2 testing is done as part of a diagnostic process for people with breast cancer. HER2 testing is performed on the same biopsy sample and shows whether there are extra copies of the HER2 gene or a higher than normal level of the HER2 protein within breast cancer cells.
Having extra copies of the HER2 gene or more than normal levels of the HER2 protein can cause breast cancer cells to grow and spread more quickly. Knowing a patient’s HER2 status helps doctors understand a patient’s prognosis and decide if therapies that target HER2 are appropriate.
It is possible for a breast tumor to have several different combinations of ER/PR and HER-2 status:
- ER/PR-positive and HER2-positive
- ER/PR-positive and HER2-negative
- ER/PR-negative and HER2-positive
- ER/PR-negative and HER2-negative, also known as “triple negative”
Allison KA, Hammond EH, et al. Estrogen and progesterone receptor testing in breast cancer: ASCO/CAP guideline update. J Clin Oncol. 2020;38(12):1346-1366. doi: 10.1200/JCO.19.02309
American Society of Clinical Oncology. Breast cancer: diagnosis. Updated July, 2020. Accessed November 12, 2021. https://www.cancer.net/cancer-types/breast-cancer/diagnosis
American Society of Clinical Oncology. Estrogen and progesterone receptor testing for breast cancer. Updated January 13, 2020. Accessed November 15, 2021. https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/estrogen-and-progesterone-receptor-testing-breast-cancer
Cable JK, Grider MH. Physiology, progesterone. In: StatPearls. Updated May 9, 2021. Accessed November 22, 2021. https://www.ncbi.nlm.nih.gov/books/NBK558960/
Cooke PS, Nanjappa MK, Ko C, Prins GS, Hess RA. Estrogens in male physiology. Physiol Rev. 2017;97(3):995-1043. doi:10.1152/physrev.00018.2016
Delgado BJ, Lopez-Ojeda W. Estrogen. In: StatPearls. Updated April 15, 2021. Accessed November 22, 2021. https://www.ncbi.nlm.nih.gov/books/NBK538260/
Hammond EM. Hormone receptors in breast cancer: Clinical utility and guideline recommendations to improve test accuracy. In: Hayes DF, ed. UpToDate. Updated August 16, 2021. Accessed November 15, 2021. https://www.uptodate.com/contents/hormone-receptors-in-breast-cancer-clinical-utility-and-guideline-recommendations-to-improve-test-accuracy
MedlinePlus: National Library of Medicine. Estrogen receptor, progesterone receptor tests. Updated September 29, 2021. Accessed November 16, 2021. https://medlineplus.gov/lab-tests/estrogen-receptor-progesterone-receptor-tests/
National Cancer Institute. Dictionary of cancer terms: Ductal carcinoma in situ. Date unknown. Accessed November 23, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ductal-carcinoma-in-situ
National Cancer Institute. Dictionary of cancer terms: Estrogen receptor. Date unknown. Accessed November 15, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/estrogen-receptor
National Cancer Institute. Dictionary of cancer terms: Progesterone receptor. Date unknown. Accessed November 15, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/progesterone-receptor
National Cancer Institute. Pathology reports. Updated September 23, 2010. Accessed November 16, 2021. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet
National Cancer Institute. Hormone therapy for breast cancer. Updated July, 7, 2021. Accessed November 12, 2021. https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet
PDQ Adult Treatment Editorial Board. PDQ breast cancer treatment (adult): Patient version. National Cancer Institute. Updated October 4, 2021. Accessed November 15, 2021. https://www.cancer.gov/types/breast/patient/breast-treatment-pdq
Sabel MS, Hirsch A, Bellon JR. Clinical manifestations and evaluation of locoregional recurrences of breast cancer. In: Hayes DF, Chagpar AB, eds. UpToDate. Updated February 3, 2021. Accessed November 16, 2021. https://www.uptodate.com/contents/clinical-manifestations-and-evaluation-of-locoregional-recurrences-of-breast-cancer