For as long as I have worked in women’s health, I have heard the same script. Estrogen “feeds” breast cancer. The safest thing we can do is block it, hard and for as long as possible. Aromatase inhibitors, tamoxifen, and the other endocrine drugs are framed as our best hope.

A woman finishes five years of endocrine therapy. She did everything that her oncology team told her to do. She took the pill every day. She lived with the hot flashes, the aching joints, the foggy brain, the sleepless nights. She was told this treatment would lower her chance of the cancer returning.

And then, years later, it comes back anyway.

I hear this story more often than most women are ever told to expect. And when it happens, the question we ask is almost always the wrong one. We ask…..