How do you approach recommending tamoxifen in a premenopausal woman with Li Fraumeni syndrome and early stage low risk ER+ breast cancer?  

The risk of uterine sarcoma is 17 per 100,000 patients per year on tamoxifen which is higher than the average population, i.e., 2 per 100,000 patients per year. The lifetime risk of soft tissue sarcoma in Li Fraumeni Syndrome (LFS) female patients is about 15%. In a series of 64 LFS breast cancer pa...