American Board of Internal Medicine (ABIM) Certification Practice Exam

After menopause, which medication can be prescribed for breast cancer prophylaxis?

1. Tamoxifen

2. Palbociclib

3. Raloxifene

4. Letrozole

The correct answer is: Raloxifene

Raloxifene is a selective estrogen receptor modulator (SERM) that is specifically indicated for breast cancer prophylaxis in women who are at high risk for developing the disease. After menopause, women experience a decrease in estrogen levels, which affects the growth of certain cancers. Raloxifene works by mimicking estrogen in some tissues (such as bone, where it has a protective effect against osteoporosis) while blocking its actions in other tissues (such as breast tissue), thereby reducing the risk of breast cancer in postmenopausal women. Tamoxifen is another SERM that can also be used for breast cancer prevention, but it is more commonly associated with treatment rather than prophylaxis in postmenopausal women. Palbociclib is a CDK 4/6 inhibitor used primarily in the treatment of hormone receptor-positive breast cancer rather than for prevention. Letrozole is an aromatase inhibitor used in the treatment of hormone receptor-positive breast cancer, rather than in a preventive capacity. In summary, Raloxifene is the most appropriate choice for breast cancer prophylaxis in postmenopausal women due to its ability to selectively block estrogen in breast tissue, reducing the risk of developing breast cancer while also providing other benefits