There was a significant association between high PAPP-A expression and reduced cancer-specific survival (CSS) in ER+ (HR 1.389, 95% CI 1.051-1.836, p = 0.021) but not ER- patients (HR 1.040, 95% CI 0.712-1.598, p = 0.838). The gene discussed is PAPPA; the disease is cancer.