A 45-year-old premenopausal woman with hormone receptor-positive HER2-negative early breast cancer completes 5 years of adjuvant tamoxifen. Genomic profiling reveals a high recurrence score. According to the ATLAS trial findings, what is the recommended extended adjuvant hormonal strategy?

• A Continue tamoxifen for an additional 5 years (total 10 years) ✓
• B Switch to an aromatase inhibitor for 5 more years immediately
• C Discontinue all hormonal therapy as 5 years is adequate
• D Add ovarian suppression with goserelin for 2 years

Explanation

The ATLAS trial (Davies et al., Lancet 2013) demonstrated that continuing tamoxifen for 10 years (rather than stopping at 5 years) significantly reduced breast cancer recurrence and mortality, especially in ER-positive disease — a 3.7% absolute reduction in breast cancer mortality over 15 years. This benefit was more pronounced in premenopausal women, for whom aromatase inhibitors are not first-line. The aTTom trial corroborated these findings. Ovarian suppression may be added per SOFT/TEXT results but is an additional, not alternative, strategy.

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.