Summary The effect of systemic therapy on tumour oestrogen receptor (ER) concentration has been studied in 88 patients with large, operable, primary tumours (total 89) of the breast. In 26 patients, tumour was not available for study on one occasion (usually post-treatment). Forty-five patients were treated initially by endocrine therapy but, of these, 13 who had failed to respond went on to receive chemotherapy also. Seventeen patients with low concentrations of ER (<20 fmol mg-' protein) were treated directly by chemotherapy. Patients underwent an incisional biopsy for confirmation of diagnosis and determination of pre-treatment ER by radioligand binding assay, followed by systemic therapy for 3 months (or 6 months for both endocrine and cytotoxic therapies). Following 3 months of systemic therapy (6 months when patients received both endocrine and cytotoxic therapies), patients proceeded on to mastectomy and axillary lymphnode clearance. When residual tumour was present within the mastectomy specimen, a portion was selected for ER assay by the pathologist.In both pre-and post-treatment specimens, a section was cut from the face of the tissue portion used for receptor analysis, fixed in formol-saline and stained with haematoxylin and eosin to permit histopathological confirmation of the presence of tumour. Twenty-six patients in whom either the pre-or post-treatment specimen contained <10% tumour, as assessed by the pathologist, have been excluded from the Correspondence: R.A. Hawkins.