American Board of Internal Medicine (ABIM) Certification Practice Exam

Which type of therapy is typically used prior to menopause for breast cancer prophylaxis?

1. Raloxifene

2. Letrozole

3. Tamoxifen

4. Denosumab

The correct answer is: Tamoxifen

Tamoxifen is the therapy that is typically used prior to menopause for breast cancer prophylaxis due to its mechanism of action and clinical effectiveness. As a selective estrogen receptor modulator (SERM), tamoxifen binds to estrogen receptors in breast tissue, blocking the effects of estrogen, which can promote the growth of certain types of breast tumors. This is particularly relevant for premenopausal women, as many breast cancers that are hormone receptor-positive are fueled by estrogen. Clinical guidelines recommend tamoxifen for women at high risk of breast cancer, particularly those with a family history of the disease or specific genetic predispositions, such as BRCA mutations. The use of tamoxifen has been shown to significantly reduce the incidence of breast cancer in women who meet these criteria. Raloxifene, while also a SERM, is generally utilized for the prevention of osteoporosis in postmenopausal women rather than for breast cancer prophylaxis in premenopausal women. Letrozole is an aromatase inhibitor and is primarily indicated for postmenopausal women with estrogen receptor-positive breast cancer; it is not typically used for prophylaxis in premenopausal women. Denosumab is a monoclonal antibody used primarily for osteoporosis and certain bone-related