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Should Adjuvant Tamoxifen be delayed until after adjuvant chemotherapy in early breast cancer?

For some time there has been a rumour that it is better to delay the start of tamoxifen until after the completion of any adjuvant post-operative chemotherapy. now, a good trial by the North American Breast Intergroup, and reported at this year's American Society of Clinical Oncology meeting (Abstract 143) demonstrated a definite advantage by so delaying. The rationale of the improvement is suggested to be that the hormonal therapy 'freezes' tumour cells in some part of the cell cycle where they are not so vulnerable to some cel cycle dependent cytotoxic drugs.