American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a recommended action for women with breast cancer diagnosed before age 45?

1. They should undergo routine mammograms.

2. They need screening for BRCA mutations.

3. They should start chemotherapy.

4. They do not need further screening.

The correct answer is: They need screening for BRCA mutations.

Women diagnosed with breast cancer before the age of 45 should undergo screening for BRCA mutations because their early diagnosis places them at a higher risk for hereditary breast and ovarian cancers. Breast cancers occurring at a younger age are more likely to be linked to genetic factors, such as mutations in the BRCA1 or BRCA2 genes. Identifying these mutations is crucial for both the management of the individual patient and family members, as it may lead to additional preventive measures or treatments to reduce cancer risk. Furthermore, BRCA mutation carriers often have more aggressive forms of breast cancer, and knowledge of the mutation can guide surgical decisions, such as the consideration of prophylactic mastectomy or oophorectomy in the future. Additionally, reporting of these mutations supports family members in understanding their genetic risks, potentially leading to earlier screening and preventive strategies for them as well. Routine mammograms are typically recommended starting at age 40, but in younger women with breast cancer, the focus is on genetic evaluation and tailored management. Starting chemotherapy should be based on the specifics of the cancer diagnosis and staging, rather than solely on age. Lastly, stating that women do not need further screening bypasses the critical need for genetic testing and assessment in this high-risk population.