142 Background: The pharmacokinetics and pharmacodynamics of tamoxifen may influence the clinical outcome and tolerability of adjuvant treatment with tamoxifen in breast cancer. We investigated the effects of polymorphisms of CYP2D6, ESR1, and ESR2 for tamoxifen therapy in early stage breast cancer patients. Methods: Tissue DNA from 187 patients who received tamoxifen only as an adjuvant systemic therapy between 1997 and 2002 were extracted and genotyped for polymorphisms of CYP2D6 (*2A, *10, *14, *41) and estrogen receptor (ESR1, ESR2). While CYP2D6*10, *14 and *41 have been reported to be associated with decreased activation of tamoxifen, CYP2D6*2A, ESR1 PvuII CC and ESR2-02 GG have been associated with enhanced activity of tamoxifen. Statistical analyses include Fisher exact test, Chi-square and Kaplan-Meier analyses. Results: Median age was 43 years (range 25-49). Most of the patients (170/187) were stage I, while other patients were stage 0 (1/187) and stage II (17/187). None of the patients had nodal metastasis. Median follow-up was 100 months (7-166). Allele frequencies were as follows: CYP2D6*10, 0.69; *14, 0.02; *41, 0.01; *2A, 0.64; ESR1 PvuII C allele, 0.25; ESR2-02 G allele, 0.98. Each genotype group did not show significant differences in age, stage, pT, tumor size and follow up period. Twelve percent (24/187) had received tamoxifen therapy for less than 24 months. Of the 24 patients, 67% (16) discontinued tamoxifen therapy related to tolerability issues. Recurrence occurred in 12 patients (6.4%). There was no association between genotypes with either recurrence or tamoxifen duration < 2 years. Although statistically nonsignificant, patients with either CYP2D6*2A homozygote, ESR1 PvuII CC genotype, ESR2-02 GG genotype tended to have a longer DFS when compared concomitantly to wild-type (p=0.445). Conclusions: Polymorphsims for CYP2D6*2A,*10, *14, *41, ESR1 PvuII, ESR2-02 did not show significant associations with either recurrence or tamoxifen duration > 2 years. However, grouped analysis for CYP2D6*2A, ESR1 PvuII, ESR2-0210 genotypes need further evaluation regarding with tamoxifen outcome.