In this study, we investigated the clinical relevance and biological associations of FOXO3a protein expression, using tissue microarrays and immunohistochemistry, in a large series of patients with invasive breast cancer.FOXO3a protein expression showed both nuclear and/or cytoplasmic staining patterns. FOXO3a predominant nuclear expression was positively associated with biomarkers of good prognosis including PgR, FOXA1, and p27 expression. There was an inverse association with mitotic counts, MIB1 growth fraction, C-MYC and PIK3CA expression. With respect to patient outcome, FOXO3a nuclear localisation was associated with longer BC specific survival (p<0.001) and longer distant metastasis free interval (p=0.001), independently of the well-established breast cancer prognostic factors.In conclusion, our results demonstrate the biological and prognostic role of FOXO3a protein expression and its subcellular localization in ER-positive/luminal-like BC possibly through its involvement in controlling cell proliferation.3