In the ER+ METABRIC cohort (N = 1518), in particular, EarlyR continuous score and risk strata were statistically significantly prognostic of distant recurrence–free interval (DRFI) and breast cancer–free interval (BCFI), up to 8 years post-diagnosis (hazard ratio [HR] of EarlyR-High to EarlyR-Low for DRFI is 2.6 [95% confidence interval [CI] = 2.0 to 3.3] in ER+ overall), and subgroups of lymph node–negative (LN−), lymph node–positive (LN+), and HER2 negative patients (9). The gene discussed is ESR1; the disease is breast carcinoma.