Breast cancer growth is regulated by steroid hormones and by polypeptide hormones and growth factors. Endocrine therapies for breast cancer have been designed to interrupt estrogen signaling by either blocking its receptor (ER) or by lowering the amount of estrogen available in the cell for binding. These therapies are very effective in many patients but de novo and acquired resistance are common. Growing evidence suggests that cross-talk between ER and growth factor receptor pathways contributes to the development of this resistance. Signaling via the EGF receptor and HER-2/neu can activate both ER and the important ER coactivator AIB1. In turn, ER located in the cell membrane can activate the growth factor receptor pathways. Breast tumors with high levels of AIB1 and HER-2 may be resistant to tamoxifen because of an increase in its estrogen agonist activity.