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Breast: Adjuvant endocrine therapy (ovarian suppression)

Free question published 15 October 2026

BreastAdjuvant endocrine therapy (ovarian suppression)

A 34-year-old premenopausal woman has had breast-conserving surgery, radiotherapy and adjuvant chemotherapy for a 26 mm, grade 3, ER-positive, HER2-negative invasive ductal carcinoma with two positive axillary nodes. She remains premenopausal after chemotherapy. The multidisciplinary team judges her to be at high risk of recurrence. Which adjuvant endocrine strategy is most appropriate?

  1. AExemestane plus ovarian function suppression
  2. BFulvestrant alone
  3. CNo endocrine therapy, as she is premenopausal
  4. DAn aromatase inhibitor alone without ovarian suppression
  5. ETamoxifen alone for 5 years

Why A is correct

The combined SOFT and TEXT analysis showed that in premenopausal women with ER-positive early breast cancer, exemestane plus ovarian function suppression improved disease-free survival compared with tamoxifen plus ovarian suppression (12-year DFS absolute improvement 4.6%, HR 0.79). The benefit of intensified endocrine therapy is greatest in high-risk young women such as this patient with grade 3, node-positive disease who remains premenopausal after chemotherapy.

And why the others are not

  • BIncorrect. Fulvestrant is a metastatic-setting agent, not standard adjuvant endocrine therapy.
  • CIncorrect. ER-positive node-positive disease warrants adjuvant endocrine therapy regardless of premenopausal status.
  • DIncorrect. An aromatase inhibitor is ineffective and unsafe in a premenopausal woman without ovarian function suppression, as her ovaries continue to produce oestrogen.
  • EIncorrect. Tamoxifen alone gave the lowest disease-free survival in SOFT; a high-risk young woman benefits from added ovarian suppression and an aromatase inhibitor.

Source SOFT and TEXT - adjuvant ovarian function suppression with exemestane in premenopausal breast cancer — Pagani O, Walley BA, Fleming GF, et al. Adjuvant Exemestane With Ovarian Suppression in Premenopausal Breast Cancer: Long-Term Follow-Up of the Combined TEXT and SOFT Trials. J Clin Oncol. 2023;41(7):1376-1382.

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