The dormancy and reactivation of long-established disseminated tumor cells (DTCs) in distant organs following primary tumor resection constitute a pivotal factor contributing to tumor recurrence and pose a significant challenge in antitumor therapy.136,252–254 Breast cancer continues to recur 5-20 years post-treatment, particularly in ER+ breast cancer cases.255,256 The implication is that the distal site DTCs have remained dormant for numerous years before the clinical detectability of the tumor.257. This evidence concerns the gene ESR1 and breast carcinoma.