MCQ Surgery Answer 10

The correct answer is A.

Of the cases of breast cancer that are heritable, approximately 80% are due to mutations in BRCA1 and BRCA2. BRCA1 is associated with high risk for breast and ovarian cancer. BRCA2 is associated with a high risk of female and male breast cancer. On the basis of our current understanding, however, less than 10% of all breast cancer cases can be considered to be heritable. Therefore, the total number of breast cancer cases associated with BRCA1 and BRCA2 mutations is a small percentage of the total number of breast cancer cases.

Furthermore, there are numerous mutations that can occur in the BRCA1 and BRCA2 genes and can be related to an increased cancer risk. Some patients who have a mutation associated with cancer will not go on to develop cancer. Other patients may have a strong family history of breast cancer but no identifiable mutation. At present, therefore, screening of the general population is not recommended.

This patient has no family history and is not in a high-risk group. Her prior breast tenderness was likely mastalgia related to the premenstrual phase. Therefore, BRCA1 and 2 screening would not be recommended for this patient.

To state that BRCA1 and 2 screening should be performed after age 50 (choice B) is incorrect. As noted above, given the limitations of the testing for BRCA1 and 2 mutations, screening of the general population is not recommended.

To state that BRCA1 and 2 screening should be performed if breast pain recurs (choice C) is incorrect. This patient does not need screening, not because her breast pain has resolved, but rather because BRCA1 and 2 screening is not appropriate for the general population at this time. As noted above, her breast pain was likely cyclic mastalgia secondary to hormonal changes prior to menses.

To state that either BRCA1 screening (choice D) or BRCA2 screening (choice E) is recommended is not correct. As explained above, screening for neither of these is recommended.

Category: Surgery MCQs