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Definition of endocrine resistance
The term  'endocrine resistance' describes a resistance to estrogen signalling suppression. However, in many scientific studies endocrine resistance refers to resistance to estrogen or estrogen receptor suppression. This resistance occurs due to the development of escape pathways which provide new ways for cancer cells to survive in the presence of endocrine therapy. If a patient with ER+ breast cancer develops endocrine resistance, the endocrine therapy used to treat the cancer will no longer be effective. Approximately 30-50% of ER+ breast cancer patients will relapse as a result of endocrine resistance, proving it to be a predominant challenge in the treatment of ER+ breast cancer patients.

Types of endocrine resistance
There are two types of endocrine resistance; primary and secondary. Primary resistance can also be described as de novo resistance or intrinsic resistance, in this instance the resistance existed before any treatment was initiated. Secondary resistance is acquired. This means that it occurs after some initial response to treatment due to exposure to endocrine therapy.

Characterisation of endocrine resistance
The table below summarises how the two types of resistance are characterised in clinical settings.

Implications of resistance
Endocrine resistance in breast cancer leads to the progression of the disease and relapse. Resistance to endocrine therapy, leading to metastasis of breast cancer is one of the main reasons for death in breast cancer patients. This highlights the need for new strategies to overcome endocrine resistance and better treat ER+ breast cancer.