Endocrine Therapy Omission in Estrogen Receptor-Low (1-10%) Early Stage Breast Cancer: An Updated Analysis of the NCDB Database.

Authors

Saskia J Leonard, Tanya L Hoskin, Grace M Choong, Matthew P Goetz, Judy C Boughey

Published in

Annals of surgical oncology. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

Endocrine therapy (ET) is recommended for estrogen receptor (ER)-positive breast cancer (BC), though its benefit in ER-low (1-10%) disease remains uncertain. Using the National Cancer Database (NCDB) from 2018 to 2020, we previously found that ET omission was associated with worse survival among 7018 patients with ER-low BC treated with (neo)adjuvant chemotherapy, with 586 deaths observed (Choong et al.). Herein, we evaluate ET omission and survival in an expanded NCDB cohort.
Female patients with stage I-III ER-low BC diagnosed between 2018 and 2023 and treated with neoadjuvant chemotherapy (NAC) and/or adjuvant chemotherapy were identified. Trends in ET use were assessed from 2018 to 2023, and overall survival (OS) was analyzed for patients diagnosed from 2018 to 2022. Kaplan-Meier methods estimated OS, and multivariable Cox regression evaluated associations between ET omission and mortality.
Among 12,983 patients, 8658 received NAC (53% achieved pathologic complete response [pCR]) and 4325 received adjuvant chemotherapy alone. ET use declined significantly over time (62% in 2018 versus 33% in 2023, p < 0.001), with the greatest decline among NAC-treated patients. OS analysis included 11,136 patients (median follow-up 3.4 years; 1137 deaths). ET omission was associated with worse OS (aHR 1.24, p < 0.001), particularly in patients with residual disease (RD) after NAC (aHR 1.23, p = 0.01). ET omission was associated with worse survival in both ER 1-5% and ER 6-10% subgroups.
ET use in ER-low BC treated with chemotherapy is declining. ET omission in ER-low BC treated with NAC with residual disease was associated with significantly worse overall survival.

PMID:
42853497
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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