Tamoxifen has been used to treat advanced breast cancer for 30 years and has been the first line hormonal treatment of choice for much of this period. It is well tolerated and inexpensive, and serious side effects are rare. Survival rates are equivalent to those of chemotherapy, and although initial response rates are lower, offering a superior quality of life in initial response. Tamoxifen should not be displaced as a key therapy for advanced breast cancer without substantial and convincing data of large randomized trials. Response rates depend on the selection of patients and are higher for patients with tumors sensitive to estrogen.Tamoxifen alone has an efficacy similar to that of estrogen or progestin when used alone or in combination, but it is better tolerated than most alternative endocrine therapies. In premenopausal women there is good evidence that the combination of tamoxifen and luteinizing hormone releasing hormone (LHRH) analogue is superior to either agent alone. This benefit of hormonal therapy with tamoxifen combination does not necessarily translate to post-menopausal patients. Recently, aromatase inhibitors, the third generation have been compared with tamoxifen in postmenopausal women with advanced breast cancer and has demonstrated superior efficacy, possibly with fewer side effects.