, CHAPTER LIST
Chapter 1: Coordination of Care
Chapter 2: Diagnosis and Staging
Chapter 3: Treatment Modalities: Local and Systemic
Chapter 4: Nursing Practice: Symptom Management
Chapter 5: Psychosocial, Survivorship, and End-of-Life
Care
, Chapter 1: Breast Health — Risk Assessment and Reduction,
Screening, and Early Detection
1. A 35-year-old woman with a strong family history of breast cancer presents for risk
assessment. Her Tyrer-Cuzick (IBIS) score indicates a lifetime risk of 22%. According to
American Cancer Society (ACS) guidelines, which is the most appropriate screening
recommendation for her?
A. Annual digital mammography starting at age 40.
B. Annual digital mammography and annual breast MRI starting now.
C. Annual digital mammography and ultrasound starting at age 40.
D. Baseline breast MRI now and mammography every 2 years starting at age 45.
Answer: B
Rationale: The ACS recommends annual screening with both MRI and mammography
for women with a lifetime risk of breast cancer calculated at 20% or greater by models
that depend heavily on family history, such as Tyrer-Cuzick.
Key words: Screening, Lifetime Risk, MRI indications.
2. Which factor is considered the most significant limitation of the Gail Model (BCRAT)
when assessing a patient for hereditary breast and ovarian cancer syndrome?
A. It overestimates risk in patients with atypical hyperplasia.
B. It does not account for paternal family history of breast cancer.
C. It includes only first-degree relatives in its family history assessment.
D. It focuses primarily on lifestyle factors rather than hormonal history.
Answer: C
Rationale: The Gail Model is limited because it only considers the number of affected
first-degree relatives (mother, sister, daughter). It fails to account for second-degree
, relatives or paternal lineage, making it less accurate for suspected hereditary cases than
models like Tyrer-Cuzick.
Key words: Gail Model, Risk Assessment, Family History.
3. A 48-year-old premenopausal woman with a history of lobular carcinoma in situ (LCIS) is
discussing risk reduction strategies. Which medication is the preferred chemoprevention
agent for this patient?
A. Tamoxifen
B. Anastrozole
C. Exemestane
D. Raloxifene
Answer: A
Rationale: Tamoxifen is the gold standard for chemoprevention in premenopausal
women at high risk, including those with LCIS. Aromatase inhibitors
(Anastrozole/Exemestane) and Raloxifene are only indicated for risk reduction in
postmenopausal women.
Key words: Chemoprevention, LCIS, Tamoxifen.
4. A patient’s pathology report from a core needle biopsy shows Atypical Ductal
Hyperplasia (ADH). What is the standard clinical management for this finding?
A. Routine screening every 12 months.
B. Immediate initiation of chemotherapy.
C. Surgical excisional biopsy.
D. Repeat core needle biopsy in 3 months.
Answer: C
Rationale: ADH is considered a high-risk lesion with a significant "upstage" rate (the
possibility of finding DCIS or invasive cancer in the surrounding tissue). Therefore, a
surgical excisional biopsy is required to ensure no malignancy is present.
, Key words: ADH, Surgical Excision, High-risk lesions.
5. In the context of the BI-RADS (Breast Imaging-Reporting and Data System) classification,
a BI-RADS 3 result on a screening mammogram typically necessitates:
A. Routine screening in 1 year.
B. Short-interval follow-up (usually 6 months).
C. Immediate ultrasound-guided biopsy.
D. Referral to a surgical oncologist for mastectomy.
Answer: B
Rationale: BI-RADS 3 indicates a "probably benign" finding with a <2% chance of
malignancy. The standard of care is a short-interval follow-up (6 months) to ensure the
stability of the lesion.
Key words: BI-RADS 3, Follow-up, Imaging.
6. A 52-year-old woman is found to have "extremely dense" breast tissue (BI-RADS
Category D) on her screening mammogram. As a nurse educator, you explain that this:
A. Decreases her risk of developing breast cancer.
B. Increases the sensitivity of the mammogram.
C. Is an independent risk factor for breast cancer and masks potential lesions.
D. Requires the patient to undergo immediate prophylactic mastectomy.
Answer: C
Rationale: Dense breast tissue (Category D) is an independent risk factor for breast
cancer development. Furthermore, it creates a "masking effect" on mammography
because both dense tissue and tumors appear white, decreasing the sensitivity of the
exam.
Key words: Breast Density, BI-RADS, Masking Effect.
,7. Which of the following patients would benefit most from the use of the Tyrer-Cuzick
model over the Gail Model?
A. A woman with no family history but a history of early menarche.
B. A woman whose paternal grandmother and paternal aunt had breast cancer.
C. A woman with a history of atypical lobular hyperplasia (ALH).
D. A woman who is currently 65 years old and nulliparous.
Answer: B
Rationale: The Tyrer-Cuzick model is much more comprehensive regarding family
history, including paternal lineage and second-degree relatives, whereas the Gail model
is limited to first-degree maternal relatives.
Key words: Risk Models, Paternal History, Tyrer-Cuzick.
8. A 30-year-old woman tests positive for a BRCA1 mutation. She is not yet ready for a
prophylactic bilateral mastectomy. According to NCCN guidelines, what is the
recommended screening protocol?
A. Annual mammogram starting at age 40.
B. Semi-annual clinical breast exams and annual MRI starting at age 25.
C. Annual ultrasound only until age 50.
D. Monthly thermography and annual mammogram.
Answer: B
Rationale: For BRCA carriers, NCCN recommends increased surveillance: annual breast
MRI (with contrast) starting at age 25 and annual mammography starting at age 30,
along with clinical breast exams every 6–12 months.
Key words: BRCA1, Surveillance, MRI.
9. What is the primary biological rationale for the use of Raloxifene in breast cancer risk
reduction?
, A. It acts as a complete estrogen antagonist in all tissues.
B. It is a Selective Estrogen Receptor Modulator (SERM) that blocks estrogen in the
breast.
C. It destroys estrogen-producing cells in the adrenal glands.
D. It irreversibly binds to the aromatase enzyme.
Answer: B
Rationale: Raloxifene is a SERM that has anti-estrogenic effects in the breast tissue
(reducing cancer risk) while having estrogenic effects in the bone (preventing
osteoporosis).
Key words: Raloxifene, SERM, Risk Reduction.
10. A patient asks why she should undergo digital breast tomosynthesis (3D
mammography) instead of standard 2D digital mammography. Your best response is:
A. 3D mammography uses significantly less radiation.
B. 3D mammography is better at detecting calcifications in fatty tissue.
C. 3D mammography improves detection rates and reduces "call-back" rates, especially
in dense breasts.
D. 3D mammography eliminates the need for breast compression.
Answer: C
Rationale: Digital breast tomosynthesis (DBT) takes multiple images from different
angles to create a 3D reconstruction, which helps clinicians see "through" overlapping
dense tissue, thereby increasing cancer detection and reducing false positives.
Key words: Tomosynthesis, 3D Mammography, Dense Breasts.
11. Which modifiable lifestyle factor has the strongest evidence-based correlation with an
increased risk of postmenopausal breast cancer?
A. High caffeine intake.
Chapter 1: Coordination of Care
Chapter 2: Diagnosis and Staging
Chapter 3: Treatment Modalities: Local and Systemic
Chapter 4: Nursing Practice: Symptom Management
Chapter 5: Psychosocial, Survivorship, and End-of-Life
Care
, Chapter 1: Breast Health — Risk Assessment and Reduction,
Screening, and Early Detection
1. A 35-year-old woman with a strong family history of breast cancer presents for risk
assessment. Her Tyrer-Cuzick (IBIS) score indicates a lifetime risk of 22%. According to
American Cancer Society (ACS) guidelines, which is the most appropriate screening
recommendation for her?
A. Annual digital mammography starting at age 40.
B. Annual digital mammography and annual breast MRI starting now.
C. Annual digital mammography and ultrasound starting at age 40.
D. Baseline breast MRI now and mammography every 2 years starting at age 45.
Answer: B
Rationale: The ACS recommends annual screening with both MRI and mammography
for women with a lifetime risk of breast cancer calculated at 20% or greater by models
that depend heavily on family history, such as Tyrer-Cuzick.
Key words: Screening, Lifetime Risk, MRI indications.
2. Which factor is considered the most significant limitation of the Gail Model (BCRAT)
when assessing a patient for hereditary breast and ovarian cancer syndrome?
A. It overestimates risk in patients with atypical hyperplasia.
B. It does not account for paternal family history of breast cancer.
C. It includes only first-degree relatives in its family history assessment.
D. It focuses primarily on lifestyle factors rather than hormonal history.
Answer: C
Rationale: The Gail Model is limited because it only considers the number of affected
first-degree relatives (mother, sister, daughter). It fails to account for second-degree
, relatives or paternal lineage, making it less accurate for suspected hereditary cases than
models like Tyrer-Cuzick.
Key words: Gail Model, Risk Assessment, Family History.
3. A 48-year-old premenopausal woman with a history of lobular carcinoma in situ (LCIS) is
discussing risk reduction strategies. Which medication is the preferred chemoprevention
agent for this patient?
A. Tamoxifen
B. Anastrozole
C. Exemestane
D. Raloxifene
Answer: A
Rationale: Tamoxifen is the gold standard for chemoprevention in premenopausal
women at high risk, including those with LCIS. Aromatase inhibitors
(Anastrozole/Exemestane) and Raloxifene are only indicated for risk reduction in
postmenopausal women.
Key words: Chemoprevention, LCIS, Tamoxifen.
4. A patient’s pathology report from a core needle biopsy shows Atypical Ductal
Hyperplasia (ADH). What is the standard clinical management for this finding?
A. Routine screening every 12 months.
B. Immediate initiation of chemotherapy.
C. Surgical excisional biopsy.
D. Repeat core needle biopsy in 3 months.
Answer: C
Rationale: ADH is considered a high-risk lesion with a significant "upstage" rate (the
possibility of finding DCIS or invasive cancer in the surrounding tissue). Therefore, a
surgical excisional biopsy is required to ensure no malignancy is present.
, Key words: ADH, Surgical Excision, High-risk lesions.
5. In the context of the BI-RADS (Breast Imaging-Reporting and Data System) classification,
a BI-RADS 3 result on a screening mammogram typically necessitates:
A. Routine screening in 1 year.
B. Short-interval follow-up (usually 6 months).
C. Immediate ultrasound-guided biopsy.
D. Referral to a surgical oncologist for mastectomy.
Answer: B
Rationale: BI-RADS 3 indicates a "probably benign" finding with a <2% chance of
malignancy. The standard of care is a short-interval follow-up (6 months) to ensure the
stability of the lesion.
Key words: BI-RADS 3, Follow-up, Imaging.
6. A 52-year-old woman is found to have "extremely dense" breast tissue (BI-RADS
Category D) on her screening mammogram. As a nurse educator, you explain that this:
A. Decreases her risk of developing breast cancer.
B. Increases the sensitivity of the mammogram.
C. Is an independent risk factor for breast cancer and masks potential lesions.
D. Requires the patient to undergo immediate prophylactic mastectomy.
Answer: C
Rationale: Dense breast tissue (Category D) is an independent risk factor for breast
cancer development. Furthermore, it creates a "masking effect" on mammography
because both dense tissue and tumors appear white, decreasing the sensitivity of the
exam.
Key words: Breast Density, BI-RADS, Masking Effect.
,7. Which of the following patients would benefit most from the use of the Tyrer-Cuzick
model over the Gail Model?
A. A woman with no family history but a history of early menarche.
B. A woman whose paternal grandmother and paternal aunt had breast cancer.
C. A woman with a history of atypical lobular hyperplasia (ALH).
D. A woman who is currently 65 years old and nulliparous.
Answer: B
Rationale: The Tyrer-Cuzick model is much more comprehensive regarding family
history, including paternal lineage and second-degree relatives, whereas the Gail model
is limited to first-degree maternal relatives.
Key words: Risk Models, Paternal History, Tyrer-Cuzick.
8. A 30-year-old woman tests positive for a BRCA1 mutation. She is not yet ready for a
prophylactic bilateral mastectomy. According to NCCN guidelines, what is the
recommended screening protocol?
A. Annual mammogram starting at age 40.
B. Semi-annual clinical breast exams and annual MRI starting at age 25.
C. Annual ultrasound only until age 50.
D. Monthly thermography and annual mammogram.
Answer: B
Rationale: For BRCA carriers, NCCN recommends increased surveillance: annual breast
MRI (with contrast) starting at age 25 and annual mammography starting at age 30,
along with clinical breast exams every 6–12 months.
Key words: BRCA1, Surveillance, MRI.
9. What is the primary biological rationale for the use of Raloxifene in breast cancer risk
reduction?
, A. It acts as a complete estrogen antagonist in all tissues.
B. It is a Selective Estrogen Receptor Modulator (SERM) that blocks estrogen in the
breast.
C. It destroys estrogen-producing cells in the adrenal glands.
D. It irreversibly binds to the aromatase enzyme.
Answer: B
Rationale: Raloxifene is a SERM that has anti-estrogenic effects in the breast tissue
(reducing cancer risk) while having estrogenic effects in the bone (preventing
osteoporosis).
Key words: Raloxifene, SERM, Risk Reduction.
10. A patient asks why she should undergo digital breast tomosynthesis (3D
mammography) instead of standard 2D digital mammography. Your best response is:
A. 3D mammography uses significantly less radiation.
B. 3D mammography is better at detecting calcifications in fatty tissue.
C. 3D mammography improves detection rates and reduces "call-back" rates, especially
in dense breasts.
D. 3D mammography eliminates the need for breast compression.
Answer: C
Rationale: Digital breast tomosynthesis (DBT) takes multiple images from different
angles to create a 3D reconstruction, which helps clinicians see "through" overlapping
dense tissue, thereby increasing cancer detection and reducing false positives.
Key words: Tomosynthesis, 3D Mammography, Dense Breasts.
11. Which modifiable lifestyle factor has the strongest evidence-based correlation with an
increased risk of postmenopausal breast cancer?
A. High caffeine intake.
