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Average-risk breast cancer screening — USMLE Step 3 MCQ

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HardPreventive Medicine, Epidemiology, BiostatisticsAverage-risk breast cancer screeningUSMLE Step 3

A healthy 32-year-old BRCA1 pathogenic-variant carrier has a normal examination and has not undergone prophylactic mastectomy. Which ongoing breast-imaging strategy is recommended at her current age?

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Correct answer: E — Perform contrast-enhanced breast MRI yearly together with mammography yearly

The best answer is “Perform contrast-enhanced breast MRI yearly together with mammography yearly”. A BRCA1 pathogenic variant places her in a high-risk screening group. At age 32, screening uses both yearly contrast-enhanced MRI and yearly mammography; MRI supplements rather than replaces mammography. For BRCA1 or BRCA2 carriers, annual breast MRI begins at age 25 and annual mammography is added at age 30; both are recommended from ages 30 through 75.

Reference: NCI BRCA1 and BRCA2 (PDQ): Cancer Surveillance: https://www.cancer.gov/publications/pdq/information-summaries/genetics/brca-genes-hp-pdq