EPIDEMIOLOGY
Which region of the world has the highest incidence of breast cancer in women?
A) Asia
B) North America
C) Europe
D) Sub-Saharan Africa
A) Asia
What environmental factor has been linked to increased breast cancer risk in high-industrialization regions?
A) High exposure to UV radiation
B) Endocrine-disrupting chemicals in plastics
C) Increased alcohol consumption
D) Infrequent physical activity
B) Endocrine-disrupting chemicals in plastics
A 45 year old lady has undergone wide local excision of a breast lump proven malignant on biopsy. According to the NICE guidelines, which of the following receptor studies are routinely requested on the specimen?
A) ER
B) PR
C) HER2
D) A and B
E) A and C
F) B and C
E) A and C
In a neoadjuvant setting, what is the advantage of using dual HER2-targeted therapy (trastuzumab and pertuzumab)?
A) Decreased risk of secondary malignancies
B) Enhanced immune response against the tumor
C) Increased likelihood of pathological complete response
D) Improved bone marrow recovery
C) Increased likelihood of pathological complete response
Invasive ductal carcinoma is mostly associated with mutation of which group of genes?
A. BRCA1 & Tp53
B. BRCA2 & RB
C. BRCA1 & BRCA2
D. APC & CDK4
C. BRCA1 & BRCA2
Which subtype of breast cancer is least common in African/American population?
A: ER positive/HER negative
B: HER positive (ER positive or negative)
C: Triple negative
D: HER2 enriched
B: HER positive (ER positive or negative)
Which of the following may be protective against Breast Cancer?
A) High cortisol level
B) Lower BMI
C) Morning choronotype
D) Persistent organic pollutants
C) Morning chronotype
Which of the following is a limitation of mammography in the detection of breast cancer?
A) Limited specificity in dense breasts
B) Inability to detect microcalcifications
C) Poor sensitivity in younger women
D) Both A and C
D) Both A and C
Which of the following is a key factor in determining the eligibility for neoadjuvant treatment in breast cancer?
A) Tumor grade
B) Tumor size and resectability
C) Age of the patient
D) Presence of hormone receptors
B) Tumor size and resectability
The gene mutated in Fanconi anemia and binds to RAD51, a protein required for homologous recombination, is also mutated in breast carcinoma in both men and women. The gene referred to in above statement is
A. BRCA1
B. BRCA2
C. Rb
D. Wnt
B. BRCA2
The mean age of development of Breast Cancer in Pakistan is:
A) 36 years
B) 41 years
C) 45 years
D) 65 years
B) 41 years
According to studies, what factor might contribute to increased breast cancer risk among Asian women who immigrate to Western countries?
A) Genetic factors remain unchanged while environmental factors, like urbanization, increase breast cancer risk
B) The genetic predisposition to breast cancer becomes weaker upon immigration
C) Western women’s diets significantly decrease breast cancer risk
D) Breast cancer rates in immigrant women remain unchanged
A) Genetic factors remain unchanged while environmental factors, like urbanization, increase breast cancer risk
Which of the following breast cancer subtypes is most likely to exhibit microcalcifications on mammography?
A) Luminal A
B) Basal-like (triple-negative)
C) HER2-positive
D) Medullary carcinoma
C) HER2-positive
Which technique is used for filling defects in medial or upper inner quadrant after volume replacement procedures?
A) LICAP flap
B) MiCAP flap
C) AICAP flap
D) LTAP flap
B) MiCAP flap
The mutation in BRCA1, BRCA2 is associated with increased risk of ductal carcinoma in situ. This has the best prognosis and the biomarkers for this are,
A. ER & PR
B. HER2 & ER
C. PR & RB
D. CDK4 & CD35
A. ER & PR
What factor is a key contributor to the decrease in breast cancer mortality rates in North America and Europe Central Asia?
A) Declining fertility rates
B) Increased alcohol consumption
C) Population-level screening and early diagnosis
D) Decreased obesity rates
C) Population-level screening and early diagnosis
FEELING LUCKY?
What animal can sleep for up to three years without eating or drinking?
A) Sloth
B) Land snail
C) Koala
D) Bear
B) Land snail
Which breast cancer subtype is most strongly associated with spiculated margins on mammography?
A) Luminal-like (LL)
B) Basal-like (BL)
C) HER2-like (HL)
D) None of the above
A) Luminal-like (LL)
In which scenario would the Oncotype DX assay NOT be recommended?
A) For a patient with stage I, estrogen receptor-positive, HER2-negative breast cancer
B) For a patient with stage II, estrogen receptor-positive, HER2-negative breast cancer
C) For a patient with triple-negative breast cancer
D) For a patient with a history of recurrent breast cancer
C) For a patient with triple-negative breast cancer
Mutation in which gene is responsible for multi cancers like breast cancer, SCC of lungs, bladder cancer, osteosarcoma and soft tissue sarcoma?
A. CDK4
B. RB
C. TGF-beta
D. Wnt-encoding gene
B. RB
Which of the following subtypes of breast cancer is most commonly diagnosed in women under 40 years of age in both Western and Asian populations?
A) Luminal A
B) HER2-positive
C) Basal-like (Triple-negative)
D) Luminal B
C) Basal-like (Triple-negative)
What is the peak age of onset for breast cancer in Asia compared to the West?
A) 35–40 years in Asia, 45–50 years in the West
B) 45–50 years in Asia, 55–60 years in the West
C) 50–55 years in Asia, 60–65 years in the West
D) 55–60 years in Asia, 45–50 years in the West
B) 45–50 years in Asia, 55–60 years in the West
Which of the following histopathologic findings is most consistent with a diagnosis of medullary carcinoma of the breast?
A) A well-defined tumor with glandular structures and mucin production
B) Tumor cells with a syncytial growth pattern and lymphocytic infiltration
C) A highly fibrotic tumor with areas of necrosis and calcification
D) Tumor cells with marked pleomorphism and high mitotic activity
B) Tumor cells with a syncytial growth pattern and lymphocytic infiltration
A 25 year old lady undergoes wide local excision for a 1 cm triple negative breast tumor in the upper outer quadrant of the left breast. Axillary lymph node dissection reveals no axillary metastases. Radiation therapy would entail (NCCN guidelines):
A) Radiation therapy to the whole breast with or without boost to the tumor bed
B) Radiation to the tumor bed alone
C) Radiation therapy to the regional lymph nodes alone
D) Radiation therapy to the whole breast with or without boost to the tumor bed, and radiation to the locoregional lymph nodes
E) Radiation therapy to the whole breast and contralateral breast
D) Radiation therapy to the whole breast with or without boost to the tumor bed, and radiation to the locoregional lymph nodes
Mutation in STK11 is responsible for causing breast carcinoma. This causes other cancers of different organs. The associated syndrome is called?
A. Lynch Syndrome
B. Peutz-Jegher Syndrome
C. Gastric Hamartoma Syndrome
D. Li-Fraumeni Syndrome
B. Peutz-Jegher Syndrome