Correct Answers | Graded A+
A 44-year-old female mathematician presents to clinic
with a complaint of a mass in the right breast. Her
partner noticed this mass 2 days ago, and the patient
feels guilty because she has only had one
mammogram and does not engage in breast self-
,examination (BSE) on any regular basis. She has no
family history of breast cancer, and her prior
mammogram was ordered as a routine screening test
at age 43 years after a brief discussion with her
primary care provider. After a thorough investigation
reveals a benign cyst, what advice should be given to
this patient about screening for breast cancer in her
age group?
a. BSE is well evidenced, and all recommending
agencies agree that it should be taught and
reinforced.
b. Clinical breast examination (CBE) is superior to BSE
and should be a routine part of annual examinations
starting at age 30 years.
c. This patient was in compliance with the U.S.
Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors
prior to her current complaint.
d. Mammography is most sensitive and specific for
women in their 40s, when breast tissue is still dense
,enough to image accurately.
e. Breast cancer screening is extremely well st
c. This patient was in compliance with the U.S.
Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors
prior to her current complaint.
A 42-year-old female website developer presents for
an annual preventive examination with questions
about breast cancer screening. She is concerned
about the radiation exposure associated with
mammography and is interested in magnetic
resonance imaging (MRI) as a possible alternative for
routine screening. She is otherwise healthy with no
family history of breast, ovarian, or colon cancer.
Which of the following is true about MRI as a
screening modality for breast cancer in the general
population?
a. Breast cancer screening by MRI has been well
studied in the general population.
b. Sensitivity of screening for breast cancer increases
with breast MRI at the expense of specificity.
, c. This patient is an ideal candidate for screening via
breast MRI based on current evidence
d. Women at low lifetime risk of breast cancer (<20%)
are recommended to undergo screening MRI.
e. Known BRCA1 or BRCA2 mutation is insufficient
criteria to justify screening with breast MRI.
b. Sensitivity of screening for breast cancer increases
with breast MRI at the expense of specificity.
A 35-year-old G0P0 woman presents to clinic with a
complaint of bilateral nipple discharge. This discharge
started several weeks ago and has occurred at
irregular intervals since that time. She does not
complain of local tenderness, redness, fever, or any
other systemic symptoms aside from slightly irregular
periods over the last few months. On examination,
she is able to express a small amount of discharge,
which is sent to the laboratory and found to be
consistent with breast milk but without any signs of
blood or pus. Screening laboratories are also sent,
which reveal a normal blood count, metabolic panel,
thyroid-stimulating hormone, and human chorionic
gonadotropin (HCG) level. Further laboratories are