A 45-year-old woman presents with a 2 cm hard, irregular, non-tender lump in the upper outer quadrant of the right breast. Fine-needle aspiration cytology shows malignant ductal cells. Sentinel lymph node biopsy is negative. Immunohistochemistry reveals ER+/PR+/HER2-. What is the most appropriate initial systemic therapy?
- A Trastuzumab monotherapy
- B Tamoxifen (hormone receptor-positive premenopausal) ✓
- C Neoadjuvant anthracycline-based chemotherapy
- D Aromatase inhibitor without further workup
Correct answer: B. Tamoxifen (hormone receptor-positive premenopausal)
Explanation
This premenopausal woman has an ER+/PR+ HER2-negative early breast cancer with negative sentinel nodes. Tamoxifen, a selective estrogen receptor modulator, is the standard adjuvant endocrine therapy for premenopausal women with hormone receptor-positive breast cancer. Aromatase inhibitors are reserved for postmenopausal women or as ovarian suppression combinations. Trastuzumab targets HER2 and is not indicated here. Neoadjuvant chemotherapy is not first-line for a small node-negative luminal A-type tumour.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.