AOCNP Cancer Screening and Early Detection 2 — Questions and Answers
Question 1: Which finding on a mammogram is classified as BI-RADS 5 and requires immediate biopsy?
- Probably benign finding, short-interval follow-up suggested
- Highly suggestive of malignancy, tissue sampling recommended (Correct answer)
- Incomplete, additional imaging needed
- Negative, routine screening recommended
Correct answer: Highly suggestive of malignancy, tissue sampling recommended
BI-RADS 5 indicates findings that are highly suggestive of malignancy (>95% likelihood), such as irregular spiculated masses with pleomorphic microcalcifications. Tissue biopsy is mandatory for all BI-RADS 5 findings.
Question 2: Fecal immunochemical testing (FIT) for colorectal cancer screening detects which substance in stool?
- DNA mutations from colorectal cells
- Human hemoglobin (globin protein) (Correct answer)
- Carcinoembryonic antigen (CEA)
- Bile salts and lipid byproducts
Correct answer: Human hemoglobin (globin protein)
FIT detects human hemoglobin in the stool using antibodies specific to the human globin protein. Unlike guaiac-based FOBT, FIT does not require dietary restrictions and is more specific for colorectal bleeding.
Question 3: A 55-year-old woman with a family history of Lynch syndrome undergoes genetic counseling. Which cancers are primarily associated with Lynch syndrome?
- Breast and ovarian cancer
- Colorectal and endometrial cancer (Correct answer)
- Lung and bladder cancer
- Thyroid and pancreatic cancer
Correct answer: Colorectal and endometrial cancer
Lynch syndrome (hereditary nonpolyposis colorectal cancer, HNPCC) is caused by germline mutations in mismatch repair genes (MLH1, MSH2, MSH6, PMS2) and is associated with colorectal, endometrial, ovarian, gastric, and urinary tract cancers.
Question 4: What is the recommended screening interval for average-risk colonoscopy in patients with no polyps found?
- Every 3 years
- Every 5 years
- Every 10 years (Correct answer)
- Every 15 years
Correct answer: Every 10 years
For average-risk patients with a negative colonoscopy (no adenomas or polyps), the recommended rescreening interval is 10 years, as colorectal cancer development from normal mucosa typically requires 10 or more years.
Question 5: Which statement about PSA screening for prostate cancer is most accurate per current ONCC/USPSTF guidance?
- PSA screening is universally recommended for all men over 40
- PSA screening decision should be individualized with shared decision-making for men aged 55–69 (Correct answer)
- PSA screening is not recommended for any age group
- PSA screening is only for men with a positive family history
Correct answer: PSA screening decision should be individualized with shared decision-making for men aged 55–69
The USPSTF and most oncology organizations recommend individualized, shared decision-making regarding PSA screening for men aged 55–69, acknowledging benefits of early detection alongside harms of overdiagnosis and overtreatment.
Question 6: Secondary prevention in oncology differs from primary prevention in that secondary prevention focuses on:
- Reducing risk factors before cancer develops
- Detecting cancer early in asymptomatic individuals (Correct answer)
- Treating cancer to prevent metastasis
- Preventing recurrence after curative therapy
Correct answer: Detecting cancer early in asymptomatic individuals
Secondary prevention involves early detection of cancer through screening programs in asymptomatic populations, enabling treatment at an earlier, more curable stage. Primary prevention aims to reduce risk factors before cancer occurs.
AOCNP Cancer Screening and Early Detection 2
Which finding on a mammogram is classified as BI-RADS 5 and requires immediate biopsy?