The estrogen levels of Asian women are different from those of Western women, and this could affect estrogen receptor (ER) bioactivity and breast cancer risk. We conducted a case-control study of 169 postmenopausal breast cancer cases and 426 matched controls nested within a population-based prospective cohort, The Singapore Chinese Health Study, to evaluate serum levels of estrogens and their receptor (ERα and ERβ)-mediated estrogenic activities in relation to breast cancer risk. Breast cancer cases had higher levels of estrogens and estrogen receptor mediated bioactivities in baseline serum than controls. Compared to the lowest quartile, women in the highest quartile for estrone or ERα-mediated bioactivity had increased breast cancer risk. After additional adjustment for ERβ bioactivity, free E2 and estrone; serum ERα-mediated estrogenic activity remained associated with increased breast cancer risk. Compared to the lowest quartile, women in the highest quartile for ERα-mediated bioactivity had an odds ratio of 2.39 (95% confidence interval=1.17–4.88, p for trend=0.016). Conversely, the positive association between estrone and cancer risk became null after adjustment for ERα-mediated estrogenic activity, suggesting that the effect of estrone could be mediated through ERα. Identification of the factor(s) contributing to increased ERα-mediated estrogenic bioactivity in sera, and its role as a predictor for breast cancer risk needs to be validated in future studies.