Genetics
The BRCA1 and BRCA2 genes are found on chromosomes:
A) 13 and 17
B) 13 and 7
C) 3 and 17
D) 17 and 13
E) 13 and X
D) BRCA1 - 17 and BRCA2 - 13
The following are risk factors for breast cancer, EXCEPT
A) Not breastfeeding
B) Dense breasts on mammography
C) Prolonged interval between menarche and 1st pregnancy
D) Low body mass index
E) Atypical ductal or lobular hyperplasia
D) Low body mass index
The Breast Imaging Reporting and Data System Classification that describes a >2% but <95% likelihood of malignancy is:
A) BI-RADS 2
B) BI-RADS 3
C) BI-RADS 4
D) BI-RADS 5
E) BI-RADS 6
C) BI-RADS 4
From the options below which is a targeted therapy for Her-2-positive breast cancers:
A) Adalimumab (Humira)
B) Pertuzumab (Perjeta)
C) Belimumab (Benlysta)
D) Bezlotoxumab (Zinplava)
B) Pertuzumab (Perjeta)
BONUS 200pts - What is a serious side effect that can happen with Her-2 targeted therapy drugs?
The mean cumulative risk of breast cancer for BRCA1 and BRCA2 mutations carriers are
A) 57% and 49%
B) 67% and 39%
C) 85% and 39%
D) 57% and 25%
E) 85% and 57%
A) 57% and 49%
Screening mammography in average risk women, per ACOG recommendations should start and end at
A) Offer at age 40, recommend at age 50, stop at age 75.
B) Offer and recommend at age 40, stop at age 70.
C) Offer and recommend at age 50, stop at age 80.
D) Offer at age 40, recommend at age 50, stop at age 65.
E) Offer and recommend at age 40, stop at age 75.
A) Offer at age 40, recommend at age 50, stop at age 75.
BONUS 200pts - What is the recommended screening modality for breast cancer in BRCA+ patients age 30 and older?
FDA approved medication to treat vasomotor symptoms in breast cancer patients:
A) Citalopram
B) Paroxetine
C) Venlafaxine
D) Gabapentin
B) Paroxetine
BONUS 200pts - Which class of non-hormonal medications for vasomotor symptoms can interfere with Tamoxifen efficacy?
The chemotherapy agent that is most associated to ovarian toxicity is
A) Cyclophosphamide
B) Cisplatin
C) Paclitaxel
D) Doxorubicin
E) 5-Fluorouracil
A) Cyclophosphamide
From the options below, which one is NOT a criteria for further genetic evaluation for Hereditary Breast Cancer:
A) Breast cancer at age 45 or less
B) Breast cancer at any age and Ashkenazi Jewish ancestry
C) Two or more close relatives with breast cancer
D) A close relative with male breast cancer
E) Breast cancer and have a close relative with breast cancer at age 50 or less
C) Two or more close relatives with breast cancer
The Gail model for breast cancer risk assessment includes the following, EXCEPT:
A) Age at first live birth
B) Age at menarche
C) Breast biopsies
D) Body mass index
E) Family history
D) Body mass index
BONUS 200pts - What is the cut off score for in the Gail model risk tool to categorize a patient high risk?
Women with atypical ductal hyperplasia...
A) have DCIS or invasive cancer in 50% of cases at time of excision.
B) should not take a risk reducing agent such as tamoxifen, raloxifene or aromatase inhibitor.
C) should stop oral contraceptives, avoid hormone replacement therapy, and make appropriate lifestyle and dietary changes.
D) should not worry as it is not associated to an increase risk of invasive breast cancer.
C) should stop oral contraceptives, avoid hormone replacement therapy, and make appropriate lifestyle and dietary changes.
All of the above are true regarding Chemotherapy induced amenorrhea, EXCEPT:
A) The overall incidence of chemotherapy-induced amenorrhea ranges from 53% to 89%.
B) Women <35 years, no matter what type of chemotherapy are low risk for permanent chemotherapy induced amenorrhea.
C) Most women who resume ovarian function after chemotherapy tend to resume menses within 1 year.
D) If menses returns, women may still have persistently poor ovarian reserve and infertility but no higher risk of premature ovarian failure.
E) Ovarian suppression with gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist therapy can be used to decrease ovarian toxicity during chemotherapy.
D) If menses returns, women may still have persistently poor ovarian reserve and infertility but no higher risk of premature ovarian failure.
Triple-negative breast cancers are
A) "Basal-like" cancers and tend to be less aggressive
B) Likely to respond to treatment with Trastuzumab
C) Common in older, white patients
D) present in about 70% of the breast cancers diagnosed in BRCA positive patients
D) present in about 70% of the breast cancers diagnosed in BRCA positive patients
In high risk women, the use of tamoxifen as prophylaxis for 5 years reduces the incidence of invasive breast cancer by:
A) 10-15%
B) 20-30%
C) 30-50%
D) 60-70%
C) 30-50% (-7 events per 1000 women)
Which statement is TRUE about benign proliferative breast lesions:
A) Fibroadenomas are the most common and they do not increase the future relative risk of breast cancer.
B) Radial scars are pseudoproliferative lesions and usually are incidental findings on biopsy. They may harbor or facilitate the development of atypical proliferations and usually are excised when found.
C) A solitary intraductal papilloma presenting with nipple discharge is usually associated with invasive or in situ carcinoma and needs to be removed.
D) Moderate (also called florid) hyperplasia of the usual type are multiple-duct epithelial cell layers (more than four) that fill the entire duct but do not have cytologic atypia. They have similar risk of future breast cancer as non proliferative simple cysts.
B) Radial scars are pseudoproliferative lesions and usually are incidental findings on biopsy. They may harbor or facilitate the development of atypical proliferations and usually are excised when found.
Use of aromatase inhibitors is NOT associated with:
A) Decrease bone mineral density
B) Arthralgia
C) Increased risk of thrombosis
D) Vaginal dryness
E) Vasomotor symptoms
C) Increased risk of thrombosis
Other gene mutations associated to increase in breast cancer risk are
A) BRIP1, CDH1, CHEK2
B) BRIP1, RAD51C, RAD51D
C) MLH1, MSH6, MSH2, PMS2, EPCAM
D) STK11, TP53, ATM, PTEN, PALB2
E) STK11, TP53, ATM, BRIP1
D) STK11, TP53, ATM, PTEN, PALB2 (CDH1 and CHEK2)
All statements regarding risk-reducing strategies for women at high risk for breast cancer are true, EXCEPT:
A) Women with BRCA mutations should be offered risk-reducing bilateral mastectomy, it reduces their risk of breast cancer by 85–100%.
B) In regards to bilateral salpingo-ophorectomy, the protective effect against breast cancer likely occurs only if patients are premenopausal at the time of risk-reducing surgery.
C) Tamoxifen use has been found to reduce the risk of breast cancer among BRCA1 mutation carrier by approximately 60%.
D) Raloxifene was found to reduce invasive breast cancer in women at increased risk.
C) Tamoxifen use has been found to reduce the risk of breast cancer among BRCA1 mutation carrier by approximately 60%. (BRCA2, no benefit found in BRCA1)
The below statements about the WHI study are true, EXCEPT:
A) Women taking unopposed estrogen had a lower breast cancer risk.
B) Combination estrogen-progesterone therapy increased the risk of breast-cancer in the population studied.
C) Mammographic breast density increased in women taking both estrogen-progesterone and unopposed estrogen HRT.
D) Breast cancer mortality in the combined estrogen-progesterone therapy group was significantly increased.
D) Breast cancer mortality in the combined estrogen-progesterone therapy group was significantly increased.
(Non-significant increase in mortality - follow up of 18 years).
Aromatase inhibitors compared to Tamoxifen as adjuvant treatment for breast cancer..
A) are more effective in decreasing risk of recurrence
B) have a higher risk of abnormal bleeding and endometrial cancer
C) have less rates of sexual dysfunction problems
D) have more vasomotor symptoms complaints
A) are more effective in decreasing risk of recurrence