American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended screening for women who received chest wall radiation at a young age?

1. Routine clinical examination

2. Annual mammograms and breast MRIs

3. Ultrasound only

4. Magnetic resonance cholangiography

The correct answer is: Annual mammograms and breast MRIs

The recommended screening for women who received chest wall radiation at a young age includes annual mammograms and breast MRIs. This approach is necessary because women with a history of chest wall radiation are at a significantly increased risk for breast cancer, particularly if the radiation was administered for conditions like Hodgkin lymphoma or other thoracic malignancies during adolescence or early adulthood. Annual mammograms help in the early detection of breast cancer by identifying abnormalities in breast tissue. However, mammograms can be less effective in younger women due to denser breast tissue, which is why breast MRI is recommended as well. MRI has a higher sensitivity for detecting breast cancer in this population, allowing for better visualization of potential tumors that might not be detected by mammography alone. Therefore, this combination of screening modalities provides the most comprehensive approach to early detection of breast cancer in women who are at an elevated risk due to their previous chest wall radiation exposure. Routine clinical examination is insufficient as a standalone method for screening, as it does not provide the detailed imaging needed to detect evolving malignancies at early stages. Ultrasound alone is also not recommended as the primary screening tool in this context, as it might miss some cancers that mammograms or MRIs would detect. Magnetic resonance cholangiography,