The study by HongChao and colleagues included 62,923 ER+ breast cancer patients and reported that the annual risk of distant recurrence was strongly related to nodal status (P < 0.001), and recurrence increased with the number of metastatic lymph nodes (20-year risk with N0, N1, and N2: 22%, 31%, and 52%) (5). This evidence concerns the gene ESR1 and breast carcinoma.