American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a key consideration in the surgical approach for inflammatory breast cancer?

1. Immediate mastectomy without prior treatment

2. Neoadjuvant chemotherapy followed by surgery

3. Lumpectomy only

4. Observation without intervention

The correct answer is: Neoadjuvant chemotherapy followed by surgery

Neoadjuvant chemotherapy followed by surgery is a key consideration in the surgical approach for inflammatory breast cancer due to the aggressive nature of this disease. Inflammatory breast cancer often presents with advanced disease at diagnosis, characterized by clinical findings such as swelling, redness, and changes in the skin of the breast. This form of cancer tends to be more responsive to systemic treatments than local treatments alone. Administering chemotherapy before surgery allows for the reduction in the size of the tumor, potentially enabling a more effective surgical intervention. This can also allow for evaluation of the tumor's response to therapy, which is crucial for planning subsequent treatment regimens. The neoadjuvant approach can lead to decreased tumor burden, increased likelihood of breast-conserving surgery, and may improve overall outcomes. In contrast, immediate mastectomy without prior treatment may not adequately address the aggressive nature of the cancer and can miss the opportunity to shrink the tumor prior to surgical intervention. Lumpectomy only is not suitable because inflammatory breast cancer typically requires more comprehensive surgical treatment. Lastly, observation without intervention is not appropriate, as this cancer requires prompt treatment to address its aggressive course.