American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended surgical intervention for women with deleterious BRCA1/2 mutations post childbearing?

1. Annual mammogram

2. Prophylactic bilateral mastectomy

3. Prophylactic bilateral salpingo-oophorectomy

4. Routine breast ultrasounds

The correct answer is: Prophylactic bilateral salpingo-oophorectomy

The recommended surgical intervention for women with deleterious BRCA1/2 mutations post-childbearing is prophylactic bilateral salpingo-oophorectomy. This procedure significantly reduces the risk of ovarian and fallopian tube cancers, which are notably increased in individuals with these genetic mutations. By removing the ovaries and fallopian tubes, the surgery also leads to a reduction in breast cancer risk, particularly when performed before the onset of menopause. In women with BRCA1/2 mutations, studies have shown that prophylactic salpingo-oophorectomy can lower the risk of developing breast cancer by approximately 50% or more, along with greatly reducing the risk of ovarian cancer, which can be as high as 44% for BRCA1 and 17% for BRCA2 by the age of 70 if no surgical intervention is undertaken. While other options, such as annual mammograms or routine breast ultrasounds, play a role in cancer detection, they do not provide a preventive effect on the onset of cancers like ovarian or fallopian tube cancer. Prophylactic bilateral mastectomy is also a preventative option that can reduce breast cancer risk, but for women already post-childbearing, the priority shifts toward ovarian cancer prevention,