American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the mainstay of treatment for metastatic breast cancer?

1. Chemotherapy

2. Surgery

3. Systemic treatment

4. Immunotherapy

The correct answer is: Systemic treatment

The mainstay of treatment for metastatic breast cancer is systemic treatment. This approach encompasses various modalities, including chemotherapy, hormonal therapy, targeted therapy, and immunotherapy, aimed at addressing cancer that has spread beyond the breast and axillary lymph nodes to other parts of the body. Systemic treatment is crucial because metastatic breast cancer is typically not amenable to local treatments like surgery or radiation, which are more effective for localized disease. The primary goal in metastatic cases is to control the disease, improve quality of life, and extend survival. While chemotherapy can be a component of the systemic approach, particularly for aggressive forms of the disease, it is not the sole or definitive treatment. Some patients may respond better to hormone therapy or targeted therapies based on the specific biology of the cancer, such as HER2-positive breast cancer benefiting from trastuzumab. Immunotherapy is growing in importance but is generally part of a broader systemic treatment strategy rather than the mainstay on its own. In summary, systemic treatment integrates various therapies tailored to the individual patient's cancer characteristics and treatment goals, making it the cornerstone of managing metastatic breast cancer effectively.