1.
ACS guidelines for how often women should get mammograms include:
Correct Answer(s)
A. Ages 40 to 44 are optional every 1 year.
B. Ages 45 to 54 are annually.
C. Ages > 55 are every 2 years.
Explanation
The ACS guidelines recommend that women aged 40 to 44 have the option to get mammograms every 1 year. For women aged 45 to 54, the guidelines recommend getting mammograms annually. Women over the age of 55 are advised to get mammograms every 2 years. Therefore, the correct answer includes these recommendations from the ACS guidelines.
2.
NCCN guidelines for how often women should get mammograms include:
Correct Answer
D. Ages 40 and above are annually
Explanation
The correct answer is ages 40 and above are annually. According to the NCCN guidelines, women aged 40 and above should get mammograms every year. This is to ensure early detection of breast cancer and increase the chances of successful treatment. Regular mammograms are especially important as women age, as the risk of developing breast cancer increases. Therefore, it is recommended that women aged 40 and above undergo annual mammograms.
3.
USPTF screening recommendations suggest women get mammograms at what age?
Correct Answer(s)
A. Ages 40 to 49 is an individual decision
B. Ages 50 to 74 should get one every year
Explanation
The USPTF screening recommendations suggest that women between the ages of 40 to 49 should make an individual decision regarding mammograms. However, for women aged 50 to 74, it is recommended that they get a mammogram every year.
4.
Which guideline recommends clinical breast exams?
Correct Answer
A. NCCN
Explanation
NCCN recommends clinical breast exams from ages 25 to 40 every 1 to 3 years and annually after the age of 40.
5.
Which guideline does not provide any information on breast awareness?
Correct Answer
A. USPTF
Explanation
USPTF has no comment on breast awareness.
6.
Mammograms are a great screening for patients of all ages.
Correct Answer
B. False
Explanation
Younger patients may need an ultrasound or MRI to confirm a tumor.
7.
Which is a benign breast disease that increases the risk of breast cancer by 4 times?
Correct Answer
A. Atypical hyperplasia
Explanation
Nonproliferative has no change in risk and proliferative, no atypia only has a slight increase of 1.2-2x.
8.
What is the gene that, when mutated, increases the risk for breast cancer?
Correct Answer
BRCA
BRCA1
BRCA2
Explanation
If a patient is young age and has a family history of breast cancer, consider genetic testing.
9.
Select all that are risk factors for breast cancer:
Correct Answer(s)
A. Early menarche (
B. Nuliparity
C. Late menopause (>54 years old)
F. Increased breast density
Explanation
Previous chest irradiation is a risk factor. Increasing age is a risk factor.
10.
Select all that are true for Ductal Carcinoma In Situ (DCIS).
Correct Answer(s)
A. It is Stage 0 in breast cancer
B. It has pre-malignant lesions
C. Lumpectomy with XRT is the preferred therapy
Explanation
Although lumpectomy with XRT (radiotherapy) is preferred, the patient could also have a mastectomy or lumpectomy followed by observation.
11.
Infiltrating ductal carcinoma is the most common type of breast cancer.
Correct Answer
A. True
Explanation
It is 85-90% of breast cancer cases.
12.
A tumor that is ____ and has no axillary node involvement has a favorable prognosis.
Correct Answer
A. < 2cm
Explanation
A tumor that is less than 2cm in size and has no axillary node involvement has a favorable prognosis. This means that the tumor is relatively small and has not spread to the lymph nodes, indicating a lower likelihood of metastasis and better chances of successful treatment and survival.
13.
A tumor that is ______ and has no axillary involvement has a poorer prognosis.
Correct Answer
A. > 5cm
Explanation
A tumor that is larger than 5cm and has no axillary involvement has a poorer prognosis. This means that when the tumor size exceeds 5cm and there is no spread to the axillary lymph nodes, the chances of a more negative outcome or prognosis for the patient are higher. The size of the tumor plays a significant role in determining the severity and aggressiveness of the cancer, and when it surpasses 5cm, it indicates a more advanced stage of the disease.
14.
The size of the primary tumor is the most important prognostic factor.
Correct Answer
B. False
Explanation
The number of involved axillary lymph nodes is the most important prognostic factor.
15.
What is the cutoff for how many involved lymph nodes a patient can have before the survival rate starts decreasing?
Correct Answer
A. 3 nodes
Explanation
1-3 nodes involved has a better prognosis whereas 4+ nodes involved has a poorer prognosis.
16.
ER/PR positive tumors will respond to endocrine therapy.
Correct Answer
A. True
Explanation
Estrogen Receptor/Progesterone Receptor (ER/PR) positive tumors are more common in postmenopausal women. The response shows a more favorable prognosis.
17.
Which comprehensive database is the only one that predicts who will respond to chemotherapy?
Correct Answer
A. Oncotype DX
Explanation
All of these are used to aid in treatment decisions.
18.
Whether the patient gets a full mastectomy, a segmental or partial mastectomy, or a lumpectomy, survival is the same so surgery is patient preference.
Correct Answer
A. True
Explanation
The statement is true because the type of surgery a patient undergoes for breast cancer does not affect their survival rate. Whether they choose a full mastectomy, a segmental or partial mastectomy, or a lumpectomy, the survival outcome remains the same. Therefore, the decision on which surgery to pursue is based on the patient's preference.
19.
Modified radical mastectomy must always be followed by radiation.
Correct Answer
B. False
Explanation
Breast-conserving therapy (BCT) must always be followed with radiation due to a higher incidence of local recurrence. Types of BCT include a segment or partial mastectomy and lumpectomy.
20.
The Sentinal lymph node is biopsied to check for node involvement because it is the first node that receives lymph fluid from the tumor.
Correct Answer
A. True
Explanation
Preferred for Stage I and Stage II breast cancer.
21.
Regardless if the patient is hormone receptor-positive or negative, HER2-positive tumors that are greater than 1cm or are node-positive should have what on board for therapy?
Correct Answer
A. Trastuzumab
Explanation
Trastuzumab should always be added to HER2 positive tumors. If the tumor is > 2cm or there are positive lymph nodes, pertuzumab should be considered.
22.
Patients who are ER+/PR+ should always receive endocrine therapy prior to chemo.
Correct Answer
B. False
Explanation
They should always receive endocrine therapy AFTER chemo.
23.
Neoadjuvant chemotherapy should always include an anthracycline +/- a taxane.
Correct Answer
A. True
Explanation
Neoadjuvant therapy is used to debulk the tumor for a more successful surgery.
24.
Which of these drugs is an anthracycline?
Correct Answer(s)
A. Doxorubicin
B. Epirubicin
Explanation
Delayed cardiotoxicity is the DLT and HMT. Baseline EF should be obtained prior to therapy. There are lifetime maximum doses.
25.
Which of these drugs is a taxane?
Correct Answer(s)
A. Eribulin
B. Paclitaxel
C. Docetaxel
Explanation
Eribulin can be used for taxane resistance.
26.
Select all that are true for Paclitaxel:
Correct Answer(s)
A. DLT is peripHeral neuropathy
B. HMT is alopecia
C. Premeds need to be used to prevent hypersensitiviy.
Explanation
Edema is the HMT for Docetaxel
27.
Any age woman who is ER+ and/or PR+ should receive Tamoxifen when?
Correct Answer
A. After chemotherapy
Explanation
The correct answer is "After chemotherapy" because Tamoxifen is a hormonal therapy commonly used in the treatment of hormone receptor-positive (ER+ and/or PR+) breast cancer. It works by blocking the effects of estrogen on breast cancer cells. Chemotherapy is typically given before hormonal therapy to shrink tumors and kill cancer cells, so it is important to complete chemotherapy before starting Tamoxifen.
28.
Women who are on tamoxifen and become post-menopausal should:
Correct Answer(s)
A. Consider switching to an aromatase inhibitor
B. Continue tamoxifen
Explanation
The patient can either switch or remain on tamoxifen, but they need to be on the therapy for a total of 10 years.
29.
Adjuvant endocrine therapy for postmenopausal women includes:
Correct Answer(s)
A. Aromatase inhibitor for 5 years
B. Tamoxifen therapy for a total of 10 years
C. Tamoxifen therapy then aromatase inhibitor therapy for 10 years
Explanation
The correct answer is a combination of aromatase inhibitor therapy for 5 years and tamoxifen therapy for a total of 10 years. This is because adjuvant endocrine therapy for postmenopausal women with hormone receptor-positive breast cancer typically involves a sequence of these two types of medications. Aromatase inhibitors are initially used for 5 years to block the production of estrogen, followed by tamoxifen therapy for an additional 5 years to further reduce the risk of recurrence. In some cases, tamoxifen therapy may be given first for 2-3 years, followed by aromatase inhibitor therapy for a total duration of 10 years.
30.
What is the correct daily dosing for Tamoxifen?
Correct Answer
A. 20mg PO
Explanation
The correct daily dosing for Tamoxifen is 20mg PO. PO stands for "per os" which means it should be taken orally. Tamoxifen is commonly prescribed for the treatment of breast cancer and is usually taken once daily. The dosage of 20mg is the standard recommended dose for most patients.
31.
Which antidepressants are safe to take with Tamoxifen?
Correct Answer(s)
A. Venlafaxine
B. Citalopram
C. Escitalopram
D. Sertraline
Explanation
Venlafaxine, Citalopram, Escitalopram, and Sertraline are safe to take with Tamoxifen because they do not significantly interact with the drug and are not known to increase the risk of adverse effects or decrease the effectiveness of Tamoxifen. However, caution should still be exercised and it is always recommended to consult with a healthcare professional before starting any new medication. Fluoxetine and Paroxetine, on the other hand, may interact with Tamoxifen and should be avoided or used with caution under medical supervision.
32.
Dosing LH-RH every 3 months is sufficient for ovarian suppression.
Correct Answer
B. False
Explanation
Only monthly dosing can guarantee ovarian suppression.
33.
The HMT for Cyclophosphamide is:
Correct Answer
A. Hemorrhagic cystitis
Explanation
Can occur months later, patient needs to hydrate and urinate frequently.
34.
Anthracycline-containing regimens are preferred for node + breast cancer but are not more effective in HER-2/neu+ patients.
Correct Answer
B. False
Explanation
Anthracycline-containing regimens may be MORE effective in HER-2/neu+ patients.
35.
Carboplatin is included in therapy for:
Correct Answer
A. HER-2/neu + patients
Explanation
Carboplatin is included in therapy for HER-2/neu + patients because HER-2/neu is a protein that promotes the growth of cancer cells. Carboplatin is a chemotherapy drug that works by interfering with the DNA in cancer cells, preventing them from growing and dividing. Therefore, it is used specifically in patients who have HER-2/neu positive breast cancer to target and inhibit the growth of these cancer cells.
36.
Cure is no longer a goal in Stage IV breast cancer.
Correct Answer
A. True
Explanation
In Stage IV breast cancer, the cancer has spread to other parts of the body, such as the bones, lungs, or liver. At this stage, the goal of treatment shifts from curing the cancer to managing the symptoms, improving quality of life, and prolonging survival. While treatment options are available to control the disease and provide relief, complete eradication of the cancer is generally not achievable. Therefore, the statement that cure is no longer a goal in Stage IV breast cancer is true.
37.
A patient with stage IV breast cancer and bone metastases is started on Pamidronate therapy. What are some counseling points for this patient?
Correct Answer(s)
A. Calcium and Vitamin D supplementation should be used daily.
B. A dental exam needs to be done prior to therapy and no dental procedures while using this medication.
C. Data supports the the use of this drug for up to 2 years, but may benefit longer.
Explanation
Patients receiving Pamidronate therapy should be counseled to take daily calcium and vitamin D supplementation to prevent bone loss. They should also undergo a dental exam before starting the therapy and avoid any dental procedures while using the medication, as Pamidronate can cause jaw problems. The data suggests that this drug can be used for up to 2 years, but longer use may also provide benefits.
38.
An aromatase inhibitor is a good choice therapy for treatment in a premenopausal Stage IV patient.
Correct Answer
B. False
Explanation
Aromatase inhibitors should not be used alone for this patient.
39.
The treatment of choice for postmenopausal Stage IV breast cancer is:
Correct Answer
A. Anastrozole + fulvestrant
Explanation
AI therapy is preferred over Letrozole + Palbociclib because we don't know how that therapy actually affects survival.
40.
Eventually, every patient with Stage IV breast cancer develops resistance to endocrine therapy. In this case, we should switch the patient to chemotherapy.
Correct Answer
A. True
Explanation
Patients with Stage IV breast cancer typically develop resistance to endocrine therapy over time. Endocrine therapy targets hormone receptors in cancer cells, but eventually, cancer cells can become resistant to this type of treatment. When resistance occurs, switching the patient to chemotherapy is often recommended. Chemotherapy uses drugs to kill or slow the growth of cancer cells and can be effective in managing Stage IV breast cancer after endocrine therapy resistance has developed. Therefore, the statement "we should switch the patient to chemotherapy" is true.
41.
Combo therapy doesn't provide any more benefit than monotherapy in the treatment of recurrent or metastatic breast cancer.
Correct Answer
A. True
Explanation
If anything it just adds more cost and side effects.