AOCNP Cancer Screening and Early Detection 5 — Questions and Answers
Question 1: A 58-year-old woman with dense breasts on mammography has a negative mammogram. Which supplemental screening modality has the strongest evidence for increasing cancer detection in this population?
- Digital breast tomosynthesis (3D mammography) as the primary screen
- Supplemental MRI for women with extremely dense breasts and average risk
- Annual ultrasound added to mammography (Correct answer)
- Thermography of the breasts
Correct answer: Annual ultrasound added to mammography
Supplemental ultrasound increases cancer detection by approximately 4 per 1,000 women with dense breasts, though it also increases false-positive rates; MRI is reserved for higher-risk women.
Question 2: Which stool-based colorectal cancer screening test requires the MOST frequent testing interval?
- Fecal immunochemical test (FIT)
- Multi-target stool DNA test (Cologuard)
- Guaiac fecal occult blood test (gFOBT) (Correct answer)
- Fecal calprotectin
Correct answer: Guaiac fecal occult blood test (gFOBT)
The guaiac FOBT (e.g., Hemoccult) requires annual testing, the same as FIT, while Cologuard is recommended every 1-3 years; all have the same annual or more frequent interval for gFOBT.
Question 3: An AOCNP is reviewing risk stratification for hepatocellular carcinoma (HCC) screening. Which patient population has a clear evidence-based indication for surveillance?
- All patients with hepatitis C virus exposure, regardless of fibrosis stage
- Patients with cirrhosis from any cause and hepatitis B carriers with high viral load or family history (Correct answer)
- Patients with NAFLD and obesity without confirmed cirrhosis
- Adults over 60 with elevated alkaline phosphatase
Correct answer: Patients with cirrhosis from any cause and hepatitis B carriers with high viral load or family history
HCC surveillance with ultrasound ± AFP every 6 months is recommended for patients with cirrhosis of any etiology and for hepatitis B carriers meeting AASLD high-risk criteria.
Question 4: A nurse practitioner counsels a 42-year-old with a strong family history of melanoma. Which statement about melanoma screening is accurate?
- Annual full-body skin exam by a dermatologist is USPSTF grade B recommended for high-risk individuals
- USPSTF states there is insufficient evidence to recommend skin cancer screening for adults in primary care (Correct answer)
- Annual dermoscopy is covered by Medicare for all patients over 40
- Monthly self-skin exams have been proven to reduce melanoma mortality in RCTs
Correct answer: USPSTF states there is insufficient evidence to recommend skin cancer screening for adults in primary care
The USPSTF issued an 'I' statement (insufficient evidence) for skin cancer screening by clinicians in asymptomatic adults, though high-risk patients are often referred to dermatology.
Question 5: Which cervical cancer screening strategy is preferred for a 35-year-old woman per current ASCCP/ACS guidelines?
- Pap smear alone every 3 years
- HPV primary testing alone every 5 years (Correct answer)
- Co-testing (Pap + HPV) every 5 years
- Annual Pap smear until age 65
Correct answer: HPV primary testing alone every 5 years
Current ACS guidelines prefer HPV primary testing every 5 years for ages 25-65; co-testing every 5 years is an acceptable alternative when primary HPV testing is unavailable.
Question 6: A 67-year-old male who smoked 1 PPD for 25 years and quit 20 years ago asks about lung cancer screening. What is the correct guidance?
- He qualifies for annual LDCT based on 25 pack-year history alone
- He does not qualify because he quit more than 15 years ago (Correct answer)
- He qualifies because age 67 falls within the 50-80 range
- He should have annual chest X-ray as an alternative
Correct answer: He does not qualify because he quit more than 15 years ago
USPSTF criteria require quitting within the past 15 years; this patient quit 20 years ago so does not meet eligibility despite age and pack-year history.
Question 7: When counseling a patient about prostate cancer screening with PSA, which shared decision-making point is MOST evidence-based?
- PSA screening clearly reduces prostate cancer mortality with minimal harms
- PSA screening may reduce prostate cancer mortality but carries risks of overdiagnosis and overtreatment (Correct answer)
- PSA screening is not recommended for any man regardless of risk
- PSA screening benefit is greatest for men over age 70
Correct answer: PSA screening may reduce prostate cancer mortality but carries risks of overdiagnosis and overtreatment
Evidence shows PSA screening may modestly reduce prostate cancer mortality but substantially increases overdiagnosis and overtreatment; individualized shared decision-making is essential.
AOCNP Cancer Screening and Early Detection 5
A 58-year-old woman with dense breasts on mammography has a negative mammogram.
Which supplemental screening modality has the strongest evidence for increasing cancer detection in this population?