I had a second opinion consultation with a very reputable breast center (UCSF) oncologist today regarding treatment. He advised against my continuing on tamoxifen because 1) it is not as effective as AIs in lessening recurrence risk 2) it has long lasting negative and serious side effects and 3) risks of DVT and endometrial cancer increase with age. He stated that the Oncotype DX test score is for now the best predictor of risk, so a drop in METS risk from 5-6% to 3%, as well as the 50% risk reduction in a new primary or regional/local breast cancer, with an estrogen blocker is worth the try. He also said that only 1 out of 3 women on an AI has terrible side effects, and even if I can only take it for one year due to SEs, that one year is better than no year, sort of like working a crummy job but still getting paid. So, in my case, I have decided to try an AI, keeping a keen eye on my bone density and taking supplements and doing strengthening exercises. I think we can all agree that we don't want any BC recurrence, a distant metastasis least of all. As my breast surgeon says, our goal is quantity (of years) and quality (of life).