How would you treat a patient with a history of ER+ breast cancer over 10 years ago, now presenting with an ER+ loco-regional recurrence while still on Tamoxifen?

Management of loco-regional recurrence is primarily local therapy. In this patient with ER positive LRR (HER2 negative), the first decision is to decide if this is operable. If operable, the first step would be surgical resection and consideration of local radiation. As far as systemic therapy, I wo...