American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of medication should postmenopausal women receive following breast cancer treatment?

1. Tamoxifen

2. Estrogen therapy

3. Aromatase inhibitor

4. Progesterone therapy

The correct answer is: Aromatase inhibitor

In postmenopausal women following breast cancer treatment, aromatase inhibitors are the preferred medication due to their mechanism of action and efficacy in reducing the risk of cancer recurrence. Aromatase inhibitors function by blocking the aromatase enzyme, which is responsible for converting androgens into estrogens. Since estrogen can promote the growth of hormone receptor-positive breast cancers, lowering its levels is crucial in the management of these patients. Aromatase inhibitors, such as letrozole, anastrozole, and exemestane, have been shown in clinical trials to be effective in improving overall survival and reducing recurrence in postmenopausal women with early-stage hormone receptor-positive breast cancer. Their use is especially beneficial because postmenopausal women have lower ovarian estrogen production, making aromatase inhibitors particularly effective in this population compared to premenopausal women. Tamoxifen, while also used in breast cancer treatment, is primarily a selective estrogen receptor modulator (SERM) and is typically reserved for premenopausal women or as a first-line treatment for some postmenopausal women depending on the specific circumstances, but it does not have the same beneficial impact as aromatase inhibitors in many postmenopausal cases. Est