A 37-year-old premenopausal woman with a 2 cm ER-positive, PR-positive, HER2-negative, node-negative invasive ductal carcinoma undergoes breast conservation surgery with clear margins and negative sentinel nodes. Which adjuvant endocrine strategy is standard for her?

• A Tamoxifen 20 mg daily for five years ✓
• B Anastrozole 1 mg daily for five years
• C Exemestane 25 mg daily for ten years
• D No endocrine therapy until menopause is confirmed

Explanation

In premenopausal women with hormone receptor-positive early breast cancer, tamoxifen 20 mg daily for five years, with consideration of extension to ten years, is the standard adjuvant endocrine therapy. Aromatase inhibitors require a low-oestrogen environment and are ineffective as monotherapy before menopause unless combined with ovarian suppression, which is reserved for higher-risk patients. Deferring endocrine therapy until menopause abandons proven mortality reduction, since tamoxifen benefits premenopausal women directly.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.