American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a significant indication for mastectomy in breast cancer patients?

1. Clear margins after excision

2. Tumors 2 cm or less

3. Tumors involving skin or chest wall

4. Unilateral breast involvement only

The correct answer is: Tumors involving skin or chest wall

Mastectomy is a surgical procedure commonly indicated for breast cancer patients under specific circumstances. One significant indication for mastectomy is when tumors involve the skin or the chest wall. This involvement suggests a more advanced disease, which may compromise the effectiveness of other treatment options. Surgical intervention in such cases is essential not only for the removal of malignant tissue but also for the reduction of the risk of local recurrence and the improvement of overall outcomes. Tumors that invade the skin or chest wall often require a more aggressive surgical approach, as the presence of cancer in these areas indicates that the disease is more likely to spread. This involvement typically necessitates a more extensive surgical procedure, such as a total mastectomy, to ensure that all cancerous tissue is removed and to facilitate subsequent treatment modalities, including radiation or chemotherapy. In contrast, factors such as having clear margins after excision, the size of the tumors being 2 cm or less, or unilateral breast involvement may not independently warrant a mastectomy. These conditions can often be managed with breast-conserving surgeries followed by additional treatments, making them less critical indicators for mastectomy compared to tumor involvement with the skin or chest wall.