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Understanding your report

What to Ask About Your — Breast Marker Results

Four results — ER, PR, HER2 and Ki-67 — determine the direction of your entire breast cancer treatment. Most people receive them without enough explanation. These are the questions that will help.

Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026

  • Four numbers, one plan — ER, PR, HER2 and Ki-67 together point toward which treatment approaches are relevant for your tumour and which are not.
  • Borderline is common — HER2 equivocal results and low ER scores are not unusual. Each has a defined next step.
  • No single number decides everything — Your oncologist weighs all four results alongside stage, tumour size and lymph node involvement.
  • You are entitled to understand — Asking for a plain-language explanation of each result before any treatment decision is made is your right.
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Your ER, PR, HER2 and Ki-67 results together determine whether hormone therapy, targeted therapy, chemotherapy or a combination is relevant for your cancer. Ask your oncologist to explain each result, what is driving the treatment recommendation, and whether any result is borderline enough to need a confirmatory test.

What does each result on your report actually mean?

ER (oestrogen receptor)
Whether oestrogen in your body is helping cancer cells grow. Reported as positive or negative, usually with a percentage score. Even a low positive score is clinically significant and changes the treatment picture.
PR (progesterone receptor)
Whether progesterone is helping cells grow. Read alongside ER — the two results usually point in the same direction, but not always. Your oncologist will explain how both are weighted together.
HER2 (human epidermal growth factor receptor 2)
A protein on cancer cell surfaces. When excess HER2 is present, the tumour tends to grow faster. Reported as positive, negative or equivocal — equivocal means a second confirmatory test is needed before the result can guide treatment.
Ki-67
How quickly cancer cells are dividing, reported as a percentage. A higher number means more rapid division. What counts as high varies between laboratories, so your team interprets your number against their own reference range.

What decides whether you need chemotherapy?

No single marker decides this. Your oncologist weighs all four results together alongside tumour size, stage and whether lymph nodes were involved.

Ki-67 is often the result families focus on most because it reflects how fast the tumour is growing. A higher number does not automatically mean more aggressive treatment — it is one input into a decision that looks at everything together.

If there is genuine uncertainty about whether chemotherapy adds enough benefit for your specific tumour, a genomic test on the tissue sample can help clarify. Your team will tell you whether this is relevant for your situation.

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What does positive, negative or borderline mean for each marker?

MarkerPositive or HighNegative or LowIf borderline or equivocal
EROestrogen is helping the tumour growOestrogen is not driving growthA low positive score is weighed alongside PR and Ki-67 — your oncologist explains how the combination changes the picture
PRProgesterone is helping the tumour growProgesterone is not driving growthUsually interpreted alongside ER — your oncologist explains how both results are weighted together
HER2Excess HER2 protein is present on cell surfacesHER2 protein is not elevatedEquivocal: a second FISH or ISH test is run on the same tissue sample to give a definitive answer
Ki-67Cells are dividing rapidlyCells are dividing slowlyCut-off points vary between laboratories — your number is interpreted against that lab's own reference range

What questions should I ask when I get my results?

Can you explain what each result means for my tumour specifically?

This is the most important question to open with. It asks your oncologist to connect the numbers on the page to your specific situation — not a general explanation of markers, but what yours mean for the tumour they found. Write the answers down. You will not retain everything from an appointment you have been dreading.

Which result is most important for deciding my treatment, and why?

All four markers matter, but in your specific case one may be carrying more weight than the others. Knowing which one, and the reason, helps you understand the logic behind what is being recommended. It also tells you where to focus if you consider a second opinion — you will know exactly which result to ask the other oncologist to look at most carefully.

Is any of my results borderline, and does it need a confirmatory test?

Borderline or equivocal results are not unusual, particularly for HER2. An equivocal result means a second test is done on the same tissue sample before that result is used to guide treatment. Ask which of your results are definitive and which, if any, are still being confirmed — and when you can expect the final answer.

Would a genomic test on my tissue change the recommendation?

Genomic tests go beyond the four standard markers and can help clarify whether chemotherapy is likely to add enough benefit to justify it. They are not relevant for every patient. Ask your oncologist whether your marker profile and stage are the type where a genomic score would change the treatment picture.

Can I have my full pathology report in writing?

You are entitled to your pathology report. Having it in writing lets you read it carefully at home, share it with family and bring it to a second opinion without delays. Ask for the full report, not a summary — summaries sometimes omit details that matter to a reviewing oncologist.

If I want a second opinion, can my tissue block be released?

A second oncologist may want to repeat marker testing on your original sample rather than relying on another centre's results. This is standard practice and is not a criticism of the first laboratory. Ask now how the tissue block can be released — knowing the process avoids delays if you later decide to proceed.

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Common questions

Frequently asked questions

What is a good Ki-67 score for breast cancer?

There is no universal threshold, because cut-off points differ between laboratories and guidance from ASCO and ESMO continues to evolve. Ask your oncologist whether your number is considered low, intermediate or high by their laboratory's standard — and what that means for your treatment plan. Comparing your result to figures found online is rarely useful without that context.

Does a positive HER2 result mean my cancer is more serious?

HER2 positive tumours do tend to grow faster. A positive result also means the tumour has a specific surface target, which shapes how treatment is approached. Whether this changes your overall outlook depends on your stage, your other markers and how the tumour responds. It is not simply bad news — it is information that changes the direction of the plan.

Can my ER and PR results point in different directions?

Yes. A tumour can be ER positive and PR negative, or carry a higher ER score alongside a low PR. This is not unusual. Your oncologist interprets both together because the combination gives a fuller picture of hormone sensitivity. If your two results differ, ask how they are being weighted and what that means for the recommendation.

What does an equivocal HER2 result mean?

Equivocal means the initial immunohistochemistry test gave a borderline result — neither clearly positive nor clearly negative. A second test called FISH or ISH is then run on the same tissue sample. This is a routine next step, not a laboratory error. Ask whether the second test has been ordered and when you can expect the result.

If I am ER positive, does that mean I definitely need hormone therapy?

ER positive means oestrogen receptors are present on the tumour cells, but it does not confirm every detail of your treatment plan on its own. Your oncologist weighs ER alongside PR, HER2, Ki-67, stage and whether you have reached menopause before deciding what is right for you. The direct answer is what your oncologist gives based on your complete results.

Can marker results change between the biopsy and surgery?

Sometimes. Pathology from a small biopsy and from the larger surgical specimen can differ, particularly if the tumour is not uniform throughout. Results are sometimes re-tested on the surgical specimen for this reason. If you receive two different sets of results, ask your oncologist which they are using to guide treatment and why.

Full index

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Every page in this section, grouped by the part of the journey it belongs to. Pick a group to see what is in it.

What Is a Biopsy?

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Types of Biopsy Compared

Which Biopsy Will You Have? Techniques Compared →

Preparing for a Biopsy

What to Expect on the Day of Your Biopsy →

Recovery and Aftercare

After a Biopsy: Recovery, Aftercare and Warning Signs →

Biopsy by Body Part

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Understanding Your Report

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IHC and Molecular Markers

IHC and Molecular Markers on a Biopsy: What They Mean →

Grading and Scoring Systems

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How Accurate Is a Biopsy?

How Accurate Is a Biopsy? Errors and Second Opinions →

If Your Result Is Benign

Your Biopsy Is Benign: What It Means and What Comes Next →

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