of the original article: Purpose: Endocrine therapies, such as tamoxifen, are commonly given to most patients with estrogen receptor (ERa)-positive breast carcinoma but are not indicated for persons with ERa-negative cancer. The factors responsible for response to tamoxifen in 5% to 10% of patients with ERa-negative tumors are not clear. The aim of the present study was to elucidate the biology and prognostic role of the second ER, ERb, in patients treated with adjuvant tamoxifen. Experimental design: We investigated ERb by immunohistochemistry in 353 stage II primary breast tumors from patients treated with 2 years adjuvant tamoxifen, and generated gene expression profiles for a representative subset of 88 tumors. Results: ERb was associated with increased survival (distant disease-free survival, P 5 0.01; overall survival, P 5 0.22), and in particular within ERa-negative patients (P 5 0.003; P 5 0.04), but not in the ERa-positive subgroup (P 5 0.49; P 5 0.88). Lack of ERb conferred early relapse (hazards ratio, 14; 95% confidence interval, 1.8-106; P 5 0.01) within the ERa-negative subgroup even after adjustment for other markers. ERa was an independent marker only within the ERb-negative tumors (hazards ratio, 0.44; 95% confidence interval, 0.21-0.89; P 5 0.02).