American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for patients with HER2-positive breast tumors 0.5 cm or larger?

1. Only hormonal therapy

2. Combination of chemotherapy and trastuzumab

3. Surgery followed by radiation

4. Only surgery as needed

The correct answer is: Combination of chemotherapy and trastuzumab

The recommended treatment for patients with HER2-positive breast tumors 0.5 cm or larger is a combination of chemotherapy and trastuzumab. This approach is grounded in the understanding of HER2-positive tumors, which tend to be more aggressive and associated with a poorer prognosis compared to HER2-negative tumors. Trastuzumab is a targeted therapy that specifically inhibits the HER2/neu receptor, significantly improving outcomes when used in conjunction with chemotherapy. This combination has been shown to enhance survival rates and reduce the risk of recurrence in patients with early-stage HER2-positive breast cancer. Utilizing only hormonal therapy, surgery, or radiation fails to address the aggressive nature of HER2-positive tumors. Hormonal therapy would not be effective in HER2-driven tumor biology, which does not rely on estrogen receptor activation. Similarly, relying solely on surgical intervention or radiation does not adequately treat the underlying disease, especially given the potential for systemic spread associated with larger HER2-positive tumors. Therefore, the optimal choice is the combination of chemotherapy and trastuzumab to improve treatment efficacy and overall survival.