8.6 Cancer Prevention, Survivorship & Psychosocial Care

ABIM Internal Medicine Exam

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1 Chapter 0: The ABIM Exam, Blueprint & Study Strategy

0.1 Exam Format, Question Types & the 2026 Blueprint 0.2 Eligibility, Registration, Fees & Exam-Day Logistics 0.3 Scoring, the Passing Standard & Score Reports 0.4 Building a Blueprint-Weighted Study Plan

2 Chapter 1: Cardiovascular Disease (14% of Exam)

1.1 Ischemic Heart Disease & Acute Coronary Syndromes 1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI 1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention 1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias 1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy 1.6 Device Therapy, HFpEF & the Cardiomyopathies 1.7 Valvular Heart Disease & Endocarditis Prophylaxis 1.8 Pericardial Disease & Acute Aortic Syndromes 1.9 Hypertension: Classification, Diagnosis & Secondary Causes 1.10 Hypertensive Crises & Dyslipidemia 1.11 Adult Congenital Heart Disease & Coarctation of the Aorta 1.12 Syncope: Reflex, Orthostatic & Cardiac Causes 1.13 Cardiac Physical Examination, Murmurs & Antithrombotic Selection

3 Chapter 2: Endocrinology, Diabetes & Metabolism (9% of Exam)

2.1 Diabetes Mellitus: Diagnosis, Glycemic Targets & Pharmacotherapy 2.2 Insulin Therapy, Hyperglycemic Emergencies & Chronic Complications 2.3 Thyroid Function Testing & Hypothyroidism 2.4 Thyrotoxicosis, Thyroid Storm & Thyroid Nodules 2.5 Adrenal & Pituitary Disorders 2.6 Hypercalcemia, Hypocalcemia & Disorders of Mineral Metabolism 2.7 Osteoporosis & Paget Disease of Bone 2.8 Ovarian, Testicular & Reproductive Endocrine Disorders 2.9 Hypoglycemia, Endocrine Tumors, Polyglandular Syndromes & Severe Hypertriglyceridemia

4 Chapter 3: Gastroenterology & Hepatology (9% of Exam)

3.1 Esophageal Disease 3.2 Stomach & Duodenal Disease and Gastrointestinal Hemorrhage 3.3 Inflammatory Bowel Disease 3.4 Celiac Disease & Irritable Bowel Syndrome 3.5 Diverticular Disease & Colorectal Cancer Screening 3.6 Viral Hepatitis, Steatotic & Alcohol-Associated Liver Disease 3.7 Cirrhosis & the Complications of Portal Hypertension 3.8 Acute Pancreatitis 3.9 Chronic Pancreatitis & Biliary Tract Disease 3.10 Inherited, Autoimmune & Drug-Induced Liver Disease 3.11 Small Intestinal Disease, Ischemia & Gastrointestinal Complications of HIV

5 Chapter 4: Infectious Disease (9% of Exam)

4.1 Lower Respiratory Tract Infections & Sepsis Syndromes 4.2 Viral Respiratory Pathogens & Tuberculosis 4.3 Central Nervous System Infections 4.4 Skin, Soft Tissue, Bone & Joint Infections 4.5 Infective Endocarditis & Cardiovascular Infection 4.6 Clostridioides difficile & Catheter-Related Bloodstream Infection 4.7 HIV Diagnosis, Antiretroviral Therapy & Prevention 4.8 Opportunistic Infections & Sexually Transmitted Infections 4.9 Fever of Unknown Origin, Neutropenic Fever & Toxic Shock 4.10 Travel-Related Illness, Vector-Borne Disease & Outbreaks 4.11 Infection Prevention, Nosocomial Infection & Postexposure Prophylaxis 4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

6 Chapter 5: Pulmonary Disease (9% of Exam)

5.1 COPD: Diagnosis, GOLD Classification & Initial Pharmacotherapy 5.2 Interventions That Reduce COPD Mortality & Exacerbation Management 5.3 Asthma: Diagnosis, Stepwise Therapy & Status Asthmaticus 5.4 Interstitial Lung Disease & Idiopathic Pulmonary Fibrosis 5.5 Sarcoidosis, Hypersensitivity Pneumonitis & Occupational Lung Disease 5.6 Pulmonary Embolism: Diagnosis, Risk Stratification & Anticoagulation 5.7 Pulmonary Hypertension & Sleep-Disordered Breathing 5.8 Acute Respiratory Distress Syndrome & Mechanical Ventilation 5.9 Pleural Disease, Empyema & Pneumothorax 5.10 Bronchiectasis, Cystic Fibrosis & Restrictive Lung Disease 5.11 Evaluation of Cough, Dyspnea, Hemoptysis & the Solitary Pulmonary Nodule

7 Chapter 6: Rheumatology & Orthopedics (9% of Exam)

6.1 Rheumatoid Arthritis: Diagnosis & Systemic Manifestations 6.2 Antirheumatic Pharmacotherapy & the Spondyloarthropathies 6.3 Gout: Pathophysiology & Acute Management 6.4 Urate-Lowering Therapy & Calcium Pyrophosphate Deposition Disease 6.5 Osteoarthritis 6.6 Systemic Lupus Erythematosus 6.7 Systemic Sclerosis, Sjogren Syndrome & Inflammatory Myopathies 6.8 The Vasculitides 6.9 Regional Musculoskeletal Syndromes, Back Pain & Sports Injuries 6.10 Other Primary Rheumatic Disorders & Mixed Connective Tissue Disease 6.11 Osteonecrosis & Metabolic Bone Disease

8 Chapter 7: Hematology (6% of Exam)

7.1 Approach to Anemia & the Microcytic Anemias 7.2 Macrocytic, Normocytic & Hemolytic Anemias 7.3 Hemoglobinopathies, Thalassemias & Paroxysmal Nocturnal Hemoglobinuria 7.4 Platelet Disorders, Thrombocytopenia & the Bleeding Patient 7.5 Coagulation Factor Disorders, Thrombophilia & Anticoagulant Reversal 7.6 Acute Leukemias, Chronic Leukemias & Myeloproliferative Neoplasms 7.7 Lymphomas & Plasma Cell Disorders 7.8 Myelodysplastic Syndrome, Myeloproliferative Neoplasms & Porphyria 7.9 Transfusion Medicine & Late Complications of Transplantation

9 Chapter 8: Medical Oncology (6% of Exam)

8.1 Breast, Lung, Colorectal & Prostate Cancer 8.2 Oncologic Emergencies 8.3 Genitourinary & Gynecologic Malignancies 8.4 Head and Neck, Bone & Soft Tissue Cancer and Cancer of Unknown Primary 8.5 Complications of Cancer & Its Treatment 8.6 Cancer Prevention, Survivorship & Psychosocial Care

10 Chapter 9: Nephrology & Urology (6% of Exam)

9.1 Acute Kidney Injury: Staging, Etiology & Urine Microscopy 9.2 Glomerular Disorders & Nephrotic Syndrome 9.3 Nephritic Syndromes, RPGN & Indications for Renal Replacement Therapy 9.4 Chronic Kidney Disease: Staging & Progression Retardation 9.5 Complications of Chronic Kidney Disease: Anemia, CKD-MBD & Acidosis 9.6 Hyponatremia, Hypernatremia & Water Balance 9.7 Potassium Disorders & Systematic Acid-Base Analysis 9.8 Renal Tubular Acidosis & Nephrolithiasis 9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions 9.10 Cystic Kidney Disease, Obstructive Uropathy, Tubulointerstitial Disease & Hematuria

11 Chapter 10: Neurology (4% of Exam)

10.1 Acute Ischemic Stroke: Syndromes & Reperfusion 10.2 Transient Ischemic Attack, Secondary Prevention & Hemorrhagic Stroke 10.3 Headache & Facial Pain 10.4 Seizures, Epilepsy & Movement Disorders 10.5 Multiple Sclerosis & Neuromuscular Junction Disorders 10.6 Motor Neuron Disease & Acute Peripheral Neuropathy 10.7 Cranial Neuropathies & Neuro-Ophthalmology 10.8 Peripheral Neuropathies, CNS Tumors & Other Neurologic Disorders

12 Chapter 11: Psychiatry & Behavioral Health (4% of Exam)

11.1 Major Depressive Disorder & Medical Mimics 11.2 Antidepressant Pharmacotherapy & Treatment-Resistant Depression 11.3 Bipolar Disorder, Mood Stabilizers & Lithium Toxicity 11.4 Anxiety, Stress-Related & Obsessive-Compulsive Disorders 11.5 Alcohol Use Disorder & Withdrawal 11.6 Pharmacotherapy for Alcohol & Opioid Use Disorder 11.7 Toxidromes, Psychiatric Emergencies & Suicide Risk Assessment 11.8 Psychotic, Somatic Symptom, Factitious & Personality Disorders 11.9 Eating Disorders, Sleep Disorders & Sexual Health

13 Chapter 12: Dermatology (3% of Exam)

12.1 Dermatitis, Papulosquamous & Inflammatory Dermatoses 12.2 Acne, Rosacea & Cutaneous Infections 12.3 Herpes Zoster & Autoimmune Blistering Diseases 12.4 Nodules, Tumors & Cutaneous Oncology 12.5 Dermatologic Emergencies & Severe Cutaneous Adverse Reactions 12.6 Pigment Disorders, Alopecia, Nail Disease & Photosensitivity 12.7 Vascular Dermatoses, Environmental Injury & Cutaneous Signs of Systemic Disease

14 Chapter 13: Obstetrics & Gynecology / Women's Health (3% of Exam)

13.1 Contraception, Preconception Care & Teratogenicity 13.2 Hypertensive Disorders of Pregnancy & Gestational Diabetes 13.3 Thyroid Disease & Venous Thromboembolism in Pregnancy 13.4 Menopause & Menopausal Hormone Therapy 13.5 Abnormal Uterine Bleeding, Endometrial Disease & Gynecologic Cancer Screening 13.6 Breast Disorders & Diseases of the Vulva and Vagina 13.7 Menstrual Disorders, Fibroids, Endometriosis & Early Pregnancy Complications

15 Chapter 14: Geriatric Syndromes (3% of Exam)

14.1 Comprehensive Geriatric Assessment & Frailty 14.2 Falls, Gait Assessment & Polypharmacy 14.3 Urinary Incontinence & Pressure Injuries in Older Adults 14.4 Mild Cognitive Impairment, Dementia & Its Subtypes 14.5 Delirium & the Pharmacotherapy of Cognitive Disorders 14.6 Palliative Care, Hospice & Advance Care Planning 14.7 Chronic Wounds, Nutrition, Swallowing, Constipation & Hip Fracture 14.8 Sensory Impairment, Dizziness, Elder Mistreatment & Care Settings

16 Chapter 15: Allergy & Immunology (2% of Exam)

15.1 Anaphylaxis: Recognition & Emergency Management 15.2 Urticaria & Angioedema 15.3 Drug Allergy, Desensitization & Adult Immunodeficiency 15.4 Food Allergy, Insect Venom Hypersensitivity, Serum Sickness & Contrast Reactions 15.5 Rhinitis, Conjunctivitis, Eosinophilic & Mast Cell Disorders

17 Chapter 16: Preventive Medicine, Immunization & Clinical Epidemiology

16.1 The USPSTF Framework & Evidence-Based Cancer Screening 16.2 Cardiovascular & Metabolic Screening and Primary Prevention 16.3 Adult Immunization & Vaccines in Special Populations 16.4 Clinical Epidemiology, Biostatistics & Study Design

18 Chapter 17: Miscellaneous - Ethics, Patient Safety & Quality Improvement (2% of Exam)

17.1 Principles of Bioethics & Decisional Capacity 17.2 Informed Consent, Treatment Refusal & Special Scenarios 17.3 Surrogate Decision-Making, Advance Directives & Confidentiality 17.4 Patient Safety Science, Medical Error & Diagnostic Reasoning 17.5 Quality Improvement Methods, Health Disparities & Health Equity

19 Chapter 18: Perioperative Medicine & Medical Consultation

18.1 Preoperative Cardiovascular Risk Assessment 18.2 Preoperative Pulmonary Risk & Perioperative Medication Management 18.3 Perioperative Anticoagulation, Bridging & Postoperative Complications

20 Chapter 19: Ophthalmology (1% of Exam)

19.1 The Acute Red Eye & Ophthalmic Emergencies 19.2 Painless Vision Loss & Chronic Ophthalmic Disease 19.3 Uveitis, Scleritis & Orbital Disease

21 Chapter 20: Otolaryngology & Dental Medicine (1% of Exam)

20.1 Dizziness, Vertigo & Epistaxis 20.2 Ear Disorders, Hearing Loss & Upper Respiratory Infections 20.3 Oral Cavity, Salivary Gland, Laryngeal & Taste and Smell Disorders

8.6 Cancer Prevention, Survivorship & Psychosocial Care

Key Takeaways Explain This Topic AI

Smoking cessation, environmental carcinogens, inherited cancer risk and lifestyle interventions are the enumerated cancer prevention topics.

Cancer survivorship is enumerated with surveillance and second malignancies as its named subtopics.

Psychosocial and financial considerations form a separate blueprint subsection under Medical Oncology.

Smoking cessation is the single most effective cancer prevention intervention and reduces risk of at least a dozen malignancies.

Survivors of chest radiation before age 30 require breast cancer surveillance with MRI plus mammography beginning about eight years after treatment.

Last updated: August 2026

• 1. Cancer Prevention
• Smoking cessation

The single highest-yield cancer prevention intervention available. Tobacco causes cancer of the lung, oral cavity, pharynx, larynx, esophagus, stomach, pancreas, liver, colorectum, kidney, bladder, cervix and myeloid leukemia. Risk declines steadily after quitting, though it does not return fully to that of a never-smoker.

Pharmacotherapy plus behavioral support is more effective than either alone. Varenicline has the highest quit rates, followed by combination nicotine replacement (a long-acting patch plus a short-acting form) and bupropion. Advise cessation at every visit, and note that e-cigarettes are not an approved cessation therapy although some patients use them for that purpose.

Chemoprevention and vaccination

HPV vaccination prevents cervical, anal, oropharyngeal, vulvar, vaginal and penile cancer.

Hepatitis B vaccination prevents hepatocellular carcinoma.

Treating hepatitis C reduces but does not eliminate hepatocellular carcinoma risk, so surveillance continues in cirrhotic patients after cure .

Treating Helicobacter pylori reduces gastric cancer risk.

Tamoxifen, raloxifene or an aromatase inhibitor reduces breast cancer incidence in selected high-risk women, and this discussion is a recognized quality measure.

Aspirin reduces colorectal cancer incidence, but is not recommended solely for that purpose because of bleeding risk.

Environmental and occupational carcinogens

• Exposure Associated cancer
• Asbestos Mesothelioma , lung cancer (multiplicative with smoking)
• Radon Lung cancer — the leading cause in never-smokers
• Benzene Acute myeloid leukemia
• Aromatic amines Bladder cancer
• Vinyl chloride Hepatic angiosarcoma
• Aflatoxin Hepatocellular carcinoma
• Arsenic Skin, lung, bladder
• Ultraviolet radiation Melanoma, basal and squamous cell carcinoma

An occupational history is part of the cancer risk assessment and is explicitly represented in the blueprint through the occupational medicine cross-content area.

Inherited cancer risk

Features that should trigger genetic evaluation:

• Cancer diagnosed at an unusually young age
• Multiple primary cancers in one person
• Bilateral disease in paired organs
• Several close relatives with the same or related cancers
• A known pathogenic variant in the family

Cancers with strong syndromic associations — male breast cancer, ovarian cancer, medullary thyroid carcinoma, pheochromocytoma, retinoblastoma

• Syndrome Gene Cancers
• Hereditary breast and ovarian BRCA1 , BRCA2 Breast, ovarian, prostate, pancreatic
• Lynch syndrome Mismatch repair genes Colorectal, endometrial , ovarian, gastric, urothelial
• Familial adenomatous polyposis APC Colorectal, duodenal, desmoid
• Li-Fraumeni TP53 Sarcoma, breast, brain, adrenocortical
• Multiple endocrine neoplasia MEN1 , RET See endocrinology
• von Hippel-Lindau VHL Renal cell, hemangioblastoma, pheochromocytoma

Genetic testing requires counseling before and after , because results affect relatives, carry psychological weight and can be misinterpreted — a variant of uncertain significance is not an actionable positive result.

Lifestyle

Maintaining a healthy weight, physical activity, limiting alcohol (a cause of oral, pharyngeal, esophageal, liver, colorectal and breast cancer, with no established safe threshold for breast cancer), limiting processed and red meat, and sun protection.

2. Cancer Survivorship

The blueprint enumerates surveillance and second malignancies as the subtopics. With survivorship now measured in decades, general internists provide most of this care.

The survivorship care plan

Every survivor should have a written summary containing:

Diagnosis, stage and treatments received — including cumulative anthracycline dose, radiation fields and doses, and all surgeries

• A surveillance schedule for recurrence
• Expected late and long-term effects
• Screening recommendations for second cancers
• Clear division of responsibility between oncology and primary care

The treatment details matter enormously, because late-effect risk is exposure-specific. A survivor who cannot say whether they received an anthracycline or where the radiation ports were cannot be risk-stratified.

Surveillance for recurrence

The governing principle is that intensive imaging and tumor marker surveillance rarely improves survival in solid tumors, and generates false positives, radiation exposure and anxiety. Most solid tumor surveillance is history, examination and targeted testing at guideline intervals.

Exceptions where surveillance genuinely changes outcomes include colorectal cancer (carcinoembryonic antigen and colonoscopy, because resectable liver metastases are curable), testicular cancer , and breast cancer (annual mammography of remaining breast tissue).

Second malignancies

Driven by treatment, shared risk factors and genetic predisposition.

Prior exposure Second cancer risk

Alkylating agents Myelodysplastic syndrome and AML, typically 5 to 7 years later, often with chromosome 5 or 7 abnormalities

Topoisomerase II inhibitors (etoposide) AML, earlier (1 to 3 years), with MLL/KMT2A rearrangement

Chest radiation before age 30 Breast cancer — begin annual MRI plus mammography about 8 years after treatment or by age 25

• Any radiation field Sarcoma, thyroid cancer, skin cancer in the field
• Hematopoietic cell transplantation Skin cancer, oral cancer, thyroid cancer

The chest radiation rule is heavily tested : a woman treated with mantle or chest irradiation for Hodgkin lymphoma as a young adult carries a breast cancer risk comparable to a BRCA carrier and requires intensified surveillance decades later.

• Late effects by system
• Cardiac — cardiomyopathy, valvular disease, accelerated coronary disease, constrictive pericarditis

Endocrine — hypothyroidism after neck radiation, hypogonadism, infertility, premature menopause, adrenal insufficiency

• Bone — osteoporosis from androgen deprivation, aromatase inhibitors, corticosteroids and premature menopause
• Neurocognitive — cancer-related cognitive impairment (chemobrain), peripheral neuropathy

Immune — functional asplenia after splenectomy or splenic irradiation, requiring vaccination and fever precautions

Psychological — depression, anxiety and fear of recurrence , the most commonly reported unmet need among survivors

Fertility preservation must be discussed before treatment , not after, because the opportunity is lost once gonadotoxic therapy begins.

3. Psychosocial and Financial Considerations

A separately enumerated blueprint subsection, reflecting recognition that these determine outcomes as much as tumor biology.

Psychosocial

Distress screening is a standard of accredited cancer care. Depression is common, under-recognized and under-treated, and it is not a normal or inevitable response to cancer that should be left alone. Somatic symptoms — fatigue, appetite loss, sleep disruption — overlap with cancer and its treatment, so diagnosis should weight anhedonia, hopelessness, worthlessness and suicidal ideation more heavily. Depression reduces treatment adherence and quality of life, and treating it improves both.

Early integration of palliative care alongside cancer-directed therapy improves quality of life and mood, and in some trials survival, while reducing aggressive end-of-life care. It is not the same as hospice and does not require stopping treatment.

Financial toxicity

The adverse effect of treatment cost on wellbeing and outcomes. It is common, largely invisible unless asked about, and clinically consequential:

• Patients ration or abandon medication because of cost, with measurably worse outcomes
• Delay or skipping of follow-up appointments and imaging
• Bankruptcy risk is elevated among cancer survivors, and financial insolvency is associated with worse survival
• Employment disruption compounds loss of insurance

What the internist can do: ask directly about affordability, because patients rarely volunteer it; involve social work and financial navigation early ; prescribe generic or lower-cost equivalents where clinically equivalent; connect patients to manufacturer assistance and foundation programs; consolidate appointments to reduce travel and lost work; and document work restrictions and disability accurately.

Caregiver burden is a recognized companion problem, with high rates of depression and financial strain among caregivers themselves, and it should be assessed rather than assumed.