How do you discuss use of tamoxifen in your stage I breast cancer patients who are > 80 years old weighing in risk of VTE with benefit from adjuvant treatment?

The risk of both thrombotic events and endometrial cancer are age-dependent in general - much of this information is best interpreted from the prevention literature, where the numbers are larger, and the impacts of co-morbidities and concomitant medications are less. With tamoxifen use, both the absolute and relative risks for endometrial cancer are higher in older women, whereas for thrombotic events, the absolute increase is clearly higher in older women since these events are generally more common in older populations (1, 2). Therefore, I only use tamoxifen in older patients with clear contraindications to aromatase inhibitor - specifically, intolerable side effects, despite interruptions, since the more silent ones such as bone mineral ...