ESR1 and metastatic neoplasm: As reported by the national cancer registry, fewer than one third of women in Jordan present with localized disease at the time of diagnosis, and 13.4% present with metastatic disease.12 In comparison, 6% in the United States and the United Kingdom present with distant metastasis.26,27 The majority (84.7%) of patients treated at KHCC between 2015 and 2017 were estrogen receptor and/or progesterone receptor positive; 8.3% had triple negative (TN) disease, and 17.7% were HER2/neu positive (unpublished data).