Purpose: There is evidence that genetic variation in the prostaglandin pathway affects cancer susceptibility and progression. Conflicting data from several studies exist for the association of PTGS2 (cyclooxygenase 2) polymorphisms with breast cancer risk.We investigated associations between common germ-line variations in seven genes in the prostaglandin pathway and breast cancer susceptibility and survival among women with invasive breast cancer in the SEARCH study. Experimental Design: DNA samples from 9,030 cases and controls were genotyped for 64 single nucleotide polymorphisms tagging known common variants (minor allele frequency > 0.05) in PTGS1, PTGS2,TBXAS1, PTGIS, PTGES, PTGDS, and PGDS with a two-stage case-control study design. Results: Four tagging single nucleotide polymorphisms showed modest association with breast cancer susceptibility. All four fit a recessive genetic model. Minor allele homozygotes for PTGISrs5602 [odds ratio (OR), 1.15; 95% confidence interval (95% CI), 1.04-1.27; P = 0.005], PTGISrs8183919 (OR, 1.22; 95% CI, 1.06-1.41; P = 0.006), and TBXASrs41727 (OR, 1.83; 95% CI, 1.22-2.73; P = 0.003) are associated with an increased risk compared with common allele carriers. For PTGISrs44627 minor allele homozygotes (OR, 0.66; 95% CI, 0.5-0.86; P = 0.002), a protective effect was observed. Conclusion: Specific PTGIS and TBXAS1 variants may affect breast cancer susceptibility, but common variants in PTGS1, PTGS2, PTGES, PTGDS, and PGDS have no major role in breast cancer susceptibility. None of the variants in the seven genes studied appear to affect survival. Further larger studies correlating clinical and genotypic data are required to establish if the clinical utility of prostaglandin-targeted therapies, as chemoprevention agents, is influenced by an individual's profile of genetic variants in key prostaglandin pathway genes.Breast cancer is the most common cancer among women in developed countries and accounts for 18% of all cancers (1). Although a few, rare, strongly predisposing alleles are well established (e.g., deleterious alleles of BRCA1 and BRCA2), these account for only 2% to 5% of all breast cancer cases (2) and <25% of the excess familial risk of breast cancer can be explained by variants in the known susceptibility genes (3). It is likely that the unexplained excess is due to multiple low to moderate risk alleles in numerous genes, that is, a polygenic model of cancer susceptibility (4).There has been increasing interest in the role of the prostaglandin pathway in both cancer susceptibility and tumor progression, with a particular focus on the enzyme cyclooxygenase (COX)