How would you approach a post-menopausal woman who now wishes to start adjuvant endocrine therapy more than 3 years since surgery?  

The short answer is yes. You start endocrine therapy even if it is late. It is important to remember that events in this disease occur later and very few events occur in the first few years anyway.  Like starting any treatment, it is a good idea to weigh risk of recurrence and value of treatme...