AOCNP Cancer Screening and Prevention 1 — Questions and Answers
Question 1: At what age does the USPSTF recommend initiating annual low-dose CT (LDCT) screening for lung cancer in high-risk individuals?
- 50 years (Correct answer)
- 45 years
- 55 years
- 60 years
Correct answer: 50 years
The USPSTF (2021 update) recommends annual LDCT screening beginning at age 50 for adults with a 20-pack-year history who currently smoke or quit within the past 10 years.
Question 2: The HPV vaccine is most effective when administered:
- Before sexual debut, ideally at age 11–12 (Correct answer)
- After first sexual exposure
- Only to females younger than 18
- At any age up to 50 without preference
Correct answer: Before sexual debut, ideally at age 11–12
HPV vaccination generates the highest immune response and provides complete protection when given before HPV exposure, which is why it is recommended at age 11–12.
Question 3: Which stool-based test detects blood AND altered DNA markers from colorectal neoplasms?
- Cologuard (stool DNA test, sDNA-FIT) (Correct answer)
- Guaiac fecal occult blood test (gFOBT)
- Fecal immunochemical test (FIT) alone
- Carcinoembryonic antigen (CEA) blood test
Correct answer: Cologuard (stool DNA test, sDNA-FIT)
Cologuard combines fecal immunochemical testing for hemoglobin with stool DNA markers (KRAS, NDRG4, BMP3 methylation) for higher sensitivity than either test alone.
Question 4: The BRCA1/2 mutation confers the highest lifetime risk for which two cancers?
- Breast and ovarian cancer (Correct answer)
- Breast and colon cancer
- Ovarian and pancreatic cancer
- Breast and lung cancer
Correct answer: Breast and ovarian cancer
BRCA1/2 mutations confer a lifetime breast cancer risk of 50–80% and ovarian cancer risk of 15–44%, with BRCA1 conferring the highest ovarian risk.
Question 5: Lynch syndrome increases lifetime risk of which cancer most significantly?
- Colorectal cancer (Correct answer)
- Breast cancer
- Lung cancer
- Prostate cancer
Correct answer: Colorectal cancer
Lynch syndrome (caused by MLH1, MSH2, MSH6, PMS2, EPCAM mutations) confers a 40–80% lifetime risk of colorectal cancer and 15–60% for endometrial cancer.
Question 6: Chemoprevention with tamoxifen is recommended for which group of high-risk women?
- Women age 35+ with ≥1.7% 5-year breast cancer risk (Gail model) who are premenopausal (Correct answer)
- All women over 50 as routine prevention
- Women with BRCA2 mutation as sole treatment
- Women with active ER-negative breast cancer
Correct answer: Women age 35+ with ≥1.7% 5-year breast cancer risk (Gail model) who are premenopausal
Tamoxifen reduces breast cancer incidence by 50% in high-risk premenopausal women with elevated 5-year risk per the Gail model, and is FDA-approved for risk reduction.
AOCNP Cancer Screening and Prevention 1
At what age does the USPSTF recommend initiating annual low-dose CT (LDCT) screening for lung cancer in high-risk individuals?