**Question:** Investigation of choice for High-risk breast cancer in female is

A. Mammography
B. Ultrasound
C. Magnetic Resonance Imaging (MRI)
D. Genetic Testing

**Core Concept:**
High-risk breast cancer refers to breast cancer in women who are at increased risk due to genetic or familial factors. The appropriate investigations depend on the underlying cause and individual risk factors.

**Why the Correct Answer is Right:**
High-risk breast cancer is typically associated with genetic mutations such as BRCA1 and BRCA2. These mutations lead to an increased risk of developing breast cancer and other malignancies. For these patients, genetic testing is essential to identify the genetic mutations and guide further management decisions.

**Why Each Wrong Option is Incorrect:**
A. Mammography: While mammography is essential for screening breast cancer in the general population, its sensitivity drops significantly in women with dense breast tissue, making it less effective for high-risk patients.
B. Ultrasound: Ultrasound can be useful in detecting early breast cancer, but it is not specific enough to identify high-risk breast cancer.
C. Magnetic Resonance Imaging (MRI): MRI is a more sensitive test for detecting breast cancer in high-risk patients, particularly those with BRCA1/2 mutations. However, false positives and false negatives can occur, and the test is not routinely recommended due to its high cost and radiation exposure from contrast media.

**Clinical Pearl:**
For high-risk breast cancer patients, genetic testing is crucial for identifying underlying mutations and guiding management decisions. Mammography and ultrasound may be less effective, and MRI has its limitations. A multidisciplinary approach involving genetic counselors, breast surgeons, and oncologists is essential for optimal care of high-risk breast cancer patients.

**Correct Answer:** D. Genetic Testing