How would you manage a middle aged woman with history of severe alcoholic liver cirrhosis and a small node negative ER/PR positive, HER2 negative breast cancer?

It is always critical to weigh absolute harms against benefits for any medical decision-making to the extent possible - ideally using validated tools when available/applicable. This should include factoring in co-morbidities and performance status. In the case of severe liver dysfunction - competing...

This is a situation where observation alone for the breast cancer would be most reasonable, considering the competing cause of mortality here. We don't have all the details, but the presence of cirrhosis appears to be established. We know the poor prognosis of this disease and we can make a reasonab...

Aromatase inhibitor.

Will avoid tamoxifen because of liver toxicity. Not a candidate for chemotherapy.