American Board of Internal Medicine (ABIM) Certification Practice Exam

At what age should women with BRCA1/2 mutations begin mammography screenings?

1. 25

2. 30

3. 35

4. 40

The correct answer is: 30

Women with BRCA1/2 mutations are at a significantly increased risk for breast cancer, and the guidelines for mammography screenings reflect the urgency of early detection in this high-risk population. The consensus among various cancer organizations, including the American Cancer Society, recommends that women with these genetic mutations should begin annual mammography screenings and MRI screenings at age 30. Starting screenings at age 30 allows for earlier detection, which is critical for improving outcomes in those at heightened risk. The rationale is based on statistics indicating that breast cancer can develop at an earlier age in these women compared to the general population. Early screening is designed to catch any potential cancers while they are still small and more treatable. The choice of beginning at age 25 is considered too early, as the potential risks and inaccuracies of screening in younger populations may not justify the benefits at that age. Delaying screenings until age 40 may miss the window for early detection, thus undermining the advantages of vigilant surveillance for those with BRCA mutations. Therefore, the recommendation to begin at age 30 aligns with the goal of balancing the risk of breast cancer with the need for effective early detection in women with BRCA1/2 mutations.