American Board of Internal Medicine (ABIM) Certification Practice Exam

For which of the following situations is mastectomy recommended in patients with invasive breast cancer?

1. For all patients regardless of tumor characteristics

2. For tumors involving the skin, chest wall, or more than one quadrant

3. Only for elderly patients

4. For patients with benign tumors

The correct answer is: For tumors involving the skin, chest wall, or more than one quadrant

Mastectomy is recommended for tumors involving the skin, chest wall, or more than one quadrant because these characteristics often indicate a more extensive disease that may not be adequately treated with breast-conserving surgery. In cases where cancer has spread to the skin or chest wall, or when multiple quadrants of the breast are affected, mastectomy provides a more comprehensive surgical approach. This is particularly important to ensure that all cancerous tissue is removed, reducing the risk of recurrence. Such situations typically involve significant tumor burden or aggressive features, making mastectomy the more effective option in managing the patient's cancer and improving long-term outcomes. In contrast, a universal recommendation for mastectomy for all patients does not consider the variability in tumor characteristics and does not take into account situations where breast-conserving therapy may be appropriate. Restricting mastectomy to elderly patients overlooks the necessary considerations regarding disease extent and individual patient circumstances. Similarly, benign tumors do not warrant a mastectomy, as they do not involve invasive cancer and are typically managed with less invasive approaches.