Tamoxifen revolutionized personalized medicine as the first targeted therapy proven to save lives in cancer. 1 The paradigm change proposed to block the breast tumor estrogen receptor (ER), apply long-term adjuvant therapy to block estrogen-stimulated recurrences, 1,2 and apply the potential of tamoxifen to prevent breast cancer. 3 These strategic recommendations were translated, during the past 3 decades, to clinical care. 1 A meta-analysis 4 of randomized clinical trials revealed that the strategic use of long-term adjuvant tamoxifen therapy is the key to therapeutic success. In addition, we now know that treating metastatic breast cancer (MBC) is only palliative at the end of life, but the same medicine saves lives if applied as long-term adjuvant therapy. Nevertheless, the question has to be asked whether the results would be the same outside the clinical trials process.The report in this issue of JAMA Oncology by Gierach and coworkers 5 is reassuring because all the rules derived, until now, from randomized clinical trial overview analyses hold true. 4 The authors 5 performed a retrospective cohort study of contralateral breast cancer (CBC) in a population of 7541 patients from the records at Kaiser Permanente Northwest and Colorado from 1990 to 2008 and followed up through 2011. The median range of observation was 6.3 years, and 248 patients were identified to have developed CBC. Both tamoxifen and aromatase inhibitors reduced CBC, and longer adjuvant therapy proved to be more beneficial than shorter therapy. The authors 5 estimate that 4 or more years of adjuvant tamoxifen therapy will prevent 3 CBCs per 100 women by 10 years after first diagnosis of ER-positive breast cancer. The authors 5 stress that patients with breast cancer who are undergoing long-term adjuvant endocrine therapy should be encouraged to complete the full course. Indeed, this conclusion is even more important because in the future adjuvant endocrine therapy will last for 10 years. 6,7 However, the challenge is adherence. Simply stated, no medicine, no benefit. A previous report 8 calculates the number of deaths caused by nonadherence with adjuvant tamoxifen therapy. Low adherence results in early recurrence, increased medical costs, and a much worse quality of life. 8 Gierach and coworkers 5 report the persistence of the protective effects of adjuvant tamoxifen after treatment stops on CBC risk and that this effect is dependent on the duration of tamoxifen therapy. The authors 5 cite a Danish study 9 that found that current users of tamoxifen had a reduced risk of CBC, 9 but former use of tamoxifen had no effect on CBC. Importantly,