A related commentary discusses these results. This study teaches us two things. First, when deciding between tamoxifen followed by exemestane and exemestane alone as adjuvant endocrine therapy, there is a trade-off between toxic effects and efficacy resulting in very similar survival outcomes with both strategies. Second, the authors confirm that patients with hormone receptor-positive breast cancer continue relapsing over time despite current endocrine therapies. We need better hormonal adjuvant approaches, particularly for high-risk groups. Two strategies are now under investigation to improve the current results: extended endocrine therapies up to 10 years and a combination of hormonal agents with other oral drugs aimed at overcoming endocrine resistance (eg, everolimus) or CDK 4-6 inhibitors In the meantime, and while awaiting the results of these trials, either an aromatase inhibitor or the sequence of an aromatase inhibitor and tamoxifen are reasonable adjuvant endocrine options for postmenopausal patients with operable, hormone receptor-positive breast cancer