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Oestrogen receptors were one of the first molecular markers of prognosis to be described in breast cancer and 10 years ago we reported our experience of their significance in predicting early recurrence of disease following surgical treatment (Cooke et al., 1979). In that study we found the presence of oestrogen receptors to be associated with both longer disease free interval and overall survival. Although our results were similar to those of several other studies (Knight et al., 1977;Allegra et al., 1979;Westerberg et al., 1980;Gapinski et al., 1980), the finding in. some later studies were inconsistent and areas of controversy have arisen. A minority of investigators failed to find any survival advantage for oestrogen receptor positive patients (Hilf et al., 1980;Alanko et al., 1984;Parl et al., 1984). In those studies in which a survival advantage has been reported for patients with oestrogen receptor positive tumours three broad areas of disagreement have emerged. These have related to the duration of time over which oestrogen receptors exert any beneficial effect, the sub-groups of patients benefiting and whether the apparently longer survival of oestrogen receptor positive patients was due to a prolonged disease free survival or longer post recurrence survival.As studies with longer follow-up than in the initial reports appeared the apparent improvement in survival amongst receptor positive patients in some studies was only present for a limited period, thereafter the survival of the two groups being similar (Raemaekers et al., 1985;Von Maillot et al., 1982;Hahnel et al., 1979; Howat et al., 1983). Although some studies found that both disease free interval and overall prognosis were prolonged in receptor positive patients (Bishop et al., 1979;Osborne et al., 1980;Rich et al., 1978) others only noted an improvement in post-relapse survival (Hahnel et al., 1979; Hilf et al., 1980; Howell et al., 1984)

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Oestrogen receptor status was related to survival in 414 patients with primary breast cancer. Women with oestrogen receptors in their tumours survived significantly longer than those without receptors; this was true for both premenopausal and postmenopausal women and also when the patients were subdivided into those with and without axillary metastases. Patients with axillary metastases and no oestrogen receptors in their tumours had the worst prognosis, while women with axillary metastases and oestrogen receptors had a death rate similar to that of women with no axillary metastases and no receptors.Patients without oestrogen receptors and with no axillary metastases were identified as a high-risk group, and it would seem appropriate to include such patients in future trials of adjuvant therapy in early breast cancer.