American Board of Internal Medicine (ABIM) Certification Practice Exam

Who qualifies for breast cancer prophylaxis?

1. Women under 30 with family history

2. Women older than 35 with a high 5-year risk

3. Women with a diagnosis of DCIS

4. Women with benign breast disease

The correct answer is: Women older than 35 with a high 5-year risk

Breast cancer prophylaxis, also known as risk-reducing strategies, is generally recommended for women who have a significantly elevated risk of developing breast cancer. A high 5-year risk is typically defined using various risk assessment tools that consider factors such as personal and family history, presence of genetic mutations (like BRCA1 and BRCA2), age, and other relevant factors. Women older than 35 with a high 5-year risk are particularly appropriate candidates for prophylaxis because they meet age criteria, combined with a high risk assessment. This consideration is crucial because the likelihood of developing breast cancer increases with age, and identifying high-risk individuals can help in making informed decisions regarding preventive measures, such as medication or surgery. Other groups mentioned, such as women under 30 with a family history, may have concerns but are generally not considered for prophylaxis unless they have a very high risk due to genetic factors. Similarly, women with a diagnosis of ductal carcinoma in situ (DCIS) typically require treatment rather than prophylaxis because they already have a form of breast cancer, and while those with benign breast disease are monitored, they do not automatically qualify for prophylactic measures unless additional high-risk factors are present.