Managing Hormone Receptor (+) and (-) Breast Cancers on the USMLE Step 2 CK exam
The Step 2 CK contains a TON of obstetrics and gynecology information. It’s not really enough to just skin over in a review book, you really have to get down and dirty and learn the ins-and-outs of OBGYN. As a rule, I suggest that my students spend at least ¼ of their study time mastering this material. It will go a long way in helping you ace the CK.
With that said, here is today’s tip to help you DOMINATE the Step 2 CK exam.
Breast cancer topics are extremely high-yield on the CK, so dedicate enough time to them in order to gain maximum amounts of points. Breast cancer topics specifically won’t make or break a great score, but they may be high enough in number that you can gain a solid 10 points on the exam by fully understanding all of the major concepts.
When discussing hormone receptors found within tumors, it is important to understand the different treatment regimens depending on whether or not it is hormone receptor negative [HR(-)] or hormone receptor positive [(+)]. Below is a short list of three common possibilities you will likely encounter on the CK exam.
If case describes HR(-), pre or post menopausal à chemo alone
If case describes HR(+), PREmenopausal à chemo + tamoxifen
If case describes HR(+), POSTmenopausal à chemo + aromatase inhibitor
Thus, if you encounter a case where a woman has a breast mass that is found to be hormone receptor negative, then whether she is pre or post menopausal the treatment will be chemotherapy.
If she is PRE-MENOPAUSAL and HR (+), then you will combine chemotherapy + tamoxifen. The reason we do not give tamoxifen to post menopausal patients is because it will exacerbate the negative symptoms associated with menopause.
And finally, a POST-MENOPAUSAL woman with a HR(+) tumor requires chemotherapy + Aromatase inhibitor (better tolerated in post-menopausal women).
For CK Domination, be sure to go through all of the key concepts associated with breast pathology and how they are managed/treated.