AOCNP Cancer Screening and Early Detection 4 — Questions and Answers
Question 1: A 45-year-old average-risk woman asks about lung cancer screening. Which criteria must she meet to qualify for low-dose CT (LDCT) screening per current USPSTF guidelines?
- Age 45-75, current smoker only
- Age 50-80, 20 pack-year history, current smoker or quit within 15 years (Correct answer)
- Age 40-75, any tobacco exposure history
- Age 55-80, 30 pack-year history, current smoker or quit within 10 years
Correct answer: Age 50-80, 20 pack-year history, current smoker or quit within 15 years
The 2021 USPSTF guidelines recommend annual LDCT for adults aged 50-80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years.
Question 2: A Lynch syndrome carrier presents for cancer risk counseling. Which screening recommendation is MOST appropriate for endometrial cancer surveillance?
- Annual Pap smear starting at age 21
- Annual endometrial biopsy or transvaginal ultrasound starting at age 30-35 (Correct answer)
- Endometrial biopsy every 5 years starting at age 40
- No surveillance needed unless symptomatic
Correct answer: Annual endometrial biopsy or transvaginal ultrasound starting at age 30-35
For Lynch syndrome carriers, annual endometrial surveillance with biopsy or transvaginal ultrasound beginning at age 30-35 is recommended due to significantly elevated endometrial cancer risk.
Question 3: Which biomarker combination is currently FDA-approved for multi-cancer early detection (MCED) screening in average-risk adults?
- CA-125 + CEA + AFP panel
- Cell-free DNA methylation pattern analysis (e.g., Galleri test) (Correct answer)
- Circulating tumor cells with PSA
- Liquid biopsy for KRAS mutations only
Correct answer: Cell-free DNA methylation pattern analysis (e.g., Galleri test)
The Galleri test analyzes cell-free DNA methylation patterns and is FDA-authorized for multi-cancer early detection, identifying signal across 50+ cancer types.
Question 4: A 52-year-old woman has a BRCA2 pathogenic variant. Regarding ovarian cancer screening, what is the evidence-based recommendation?
- Annual CA-125 plus transvaginal ultrasound is recommended
- Screening is not recommended; risk-reducing salpingo-oophorectomy is preferred (Correct answer)
- Transvaginal ultrasound every 6 months starting at age 50
- Annual pelvic MRI is the preferred modality
Correct answer: Screening is not recommended; risk-reducing salpingo-oophorectomy is preferred
Evidence shows CA-125 and transvaginal ultrasound have not reduced ovarian cancer mortality in BRCA carriers; risk-reducing salpingo-oophorectomy at appropriate age is the preferred strategy.
Question 5: During a community health fair, an NP screens attendees for oral cancer. Which finding warrants immediate referral rather than watchful waiting?
- Geographic tongue with central red area
- Erythroplakia on the floor of the mouth persisting >2 weeks (Correct answer)
- Angular cheilitis in a patient with dentures
- Small aphthous ulcer healing over 2 weeks
Correct answer: Erythroplakia on the floor of the mouth persisting >2 weeks
Erythroplakia carries up to a 51% risk of malignant transformation and persistent lesions >2 weeks require immediate biopsy referral.
Question 6: What is the recommended interval for repeat colonoscopy after removal of 3 tubular adenomas <10mm with low-grade dysplasia?
- 1 year
- 3 years (Correct answer)
- 5 years
- 10 years
Correct answer: 3 years
Current guidelines recommend a 3-year surveillance colonoscopy interval following removal of 3-4 small tubular adenomas with low-grade dysplasia.
Question 7: A 35-year-old male with a history of undescended testis (orchiopexy at age 2) asks about testicular cancer screening. What is the appropriate guidance?
- Annual scrotal ultrasound starting at age 30
- Monthly testicular self-examination with prompt evaluation of abnormalities (Correct answer)
- Serum AFP and beta-hCG every 6 months
- No formal screening is recommended; reassure there is no increased risk
Correct answer: Monthly testicular self-examination with prompt evaluation of abnormalities
While no formal screening program exists for testicular cancer, men with cryptorchidism history have 3-5x increased risk and should perform monthly testicular self-exams with immediate evaluation of any mass.
AOCNP Cancer Screening and Early Detection 4
A 45-year-old average-risk woman asks about lung cancer screening.
Which criteria must she meet to qualify for low-dose CT (LDCT) screening per current USPSTF guidelines?