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Tumour markers in malignancies

BMJ 2000; 321 doi: (Published 05 August 2000) Cite this as: BMJ 2000;321:379

Two isoforms of oestrogen receptor are now known to exist

  1. Carlo Palmieri (, CRC clinical research fellow,
  2. Sam Fishpool, medical student,
  3. R C Coombes, professor of medical oncology
  1. Cancer Cell Biology Group, Cancer Research Campaign Laboratories, Imperial College School of Medicine—Hammersmith Campus, London W12 0NN
  2. St George's Hospital Medical School, Division of Oncology, Department of Cellular and Molecular Sciences, London SW17 0RE
  3. Canterbury Health, Department of Medicine, Christchurch Hospital, PB 4710, Christchurch, New Zealand
  4. Department of Clinical Genetics, Karolinska Hospital, Stockholm, Sweden
  5. Department of South Stockholm Oncology, Huddinge University Hospital, Sweden

    EDITOR—Lindblom and Liljegren comment about oestrogen receptor in their clinical review of tumour markers in malignancies.1 They failed, however, to acknowledge that two isoforms of the receptor (ERa and ERb) are now known to exist and to distinguish between the two. This is important as it is now incorrect both scientifically and clinically to talk solely about ER as if it were one entity.

    The oestrogen receptor that they referred to is the classical oestrogen receptor or ERa2; as noted in their table, it predicts response to endocrine treatment in the adjuvant setting and correlates with a better prognosis. Not noted in their table is that ERa immunohistochemistry is used as a diagnostic investigation in patients with metastases when there is a primary of unknown origin. Also not noted is that ERa expression does not guarantee response to endocrine treatment, with 30-40% of such tumours failing to respond.3

    Oestrogen receptor β, or ERb, is the more recently discovered isoform; ERa and ERb represent two gene products with distinct biological roles and ligand binding specificity.4 With reference to the breast the expression of ERb, its role in the normal and malignant breast, the interactions between it and ERa, and its use as a tumour …

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