American Board of Internal Medicine (ABIM) Certification Practice Exam

Who should receive MRI screening for breast cancer based on American Cancer Society recommendations?

1. Women with a family history of heart disease

2. Women who had radiation to the chest wall between ages 10 and 30

3. Women diagnosed with breast cancer over 40 years of age

4. Women with a family history of colon cancer

The correct answer is: Women who had radiation to the chest wall between ages 10 and 30

The recommendation for MRI screening for breast cancer is particularly strong for women who have had radiation therapy to the chest wall, especially if this occurred when they were between the ages of 10 and 30. This population is at a significantly increased risk for developing breast cancer, often due to the effects of radiation on breast tissue during a critical period of development. Early and regular screening with MRI in these individuals is crucial, as MRI has a higher sensitivity for detecting breast cancers in women with a history of chest radiation compared to traditional mammography alone. This targeted screening helps identify malignancies that may otherwise go undetected, thereby aiding in earlier intervention and potentially improving outcomes for these high-risk patients. Other factors such as family history of heart disease or colon cancer do not directly correlate with increased breast cancer risk in the same way. Additionally, being diagnosed with breast cancer after age 40 does not necessitate routine MRI screening; rather, the management plan would typically depend on the characteristics of the breast cancer diagnosed.