American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for inflammatory breast cancer?

1. Radiation therapy alone

2. Neoadjuvant chemotherapy, followed by surgery and then radiation

3. Hormonal therapy

4. Observation without treatment

The correct answer is: Neoadjuvant chemotherapy, followed by surgery and then radiation

The first-line treatment for inflammatory breast cancer is neoadjuvant chemotherapy, which is administered before surgery, followed by surgical resection and then radiation therapy. This approach is crucial because inflammatory breast cancer is an aggressive form of breast cancer that often presents with extensive lymphatic involvement and may be locally advanced at diagnosis. Neoadjuvant chemotherapy helps to reduce the size of the tumor and decrease the extent of the disease, allowing for a more effective surgical intervention. After chemotherapy, surgery is performed to remove the remaining cancerous tissue, and radiation therapy is then used to target any residual disease in the breast or chest wall to minimize the risk of recurrence. Hormonal therapy is not the first-line treatment for inflammatory breast cancer, as this type of breast cancer is often hormone receptor-negative and tends to not respond favorably to hormonal treatments. Radiation therapy alone is insufficient as a primary treatment because it does not address the systemic nature of the disease. Similarly, observation without treatment is not an appropriate approach for a malignancy as aggressive as inflammatory breast cancer. This comprehensive treatment strategy of chemotherapy, surgery, and radiation reflects the understanding of the disease’s biology and the need for a multifaceted approach.