Abstract
Worldwide breast cancer is most frequently diagnosed and leading cause of cancer related deaths in women. Hormone therapy, Tamoxifen is recommended in ER+ve patients.10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis.A 32-year-old woman was having a large palpable lump in the lower inner quadrant of breast measuring 6*5cm for last 4months, for which a biopsy was taken, and it was invasive ductal carcinoma, grade II. She presented to INMOL in September 2010 after upfront MRM surgery.The patient had no co-morbidities and 4 cycles of FAC followed by 4 cycles of paclitaxel were given and chemotherapy was completed on Feb,2011.Patient was treated on Co-60, giving a dose of 40Gy/15 Fractions with 2 tangential fields ,one anterior supraclavicular fossa field plus posterior axillary boost . The patient was given 20 mg of tamoxifen daily and put on follow-up. Patient remained well while on tamoxifen. Tamoxifen stopped after 10 years. After 3 years of stopping tamoxifen she was presented in June 2023 she developed bone and pulmonary mets.After stabilization, palliative radiotherapy was given with dose 12Gy/2 fractions. After one month, patient’s symptoms were much better so tamoxifen treatment continued.in our case ER,PR +ve ,her2 negative node positive disease, disease recurred with distant bony and pulmonary metastasis after discontinuing tamoxifen suggests that in premenopausal younger patients with heavy burden disease like positive axillary nodes, tamoxifen should be continued even after 10 years.