AOCNP Cancer Screening and Prevention 4 — Questions and Answers
Question 1: A 45-year-old woman with BRCA1 mutation asks about breast cancer screening recommendations. Which protocol is most appropriate?
- Annual mammogram starting at age 40 only
- Annual MRI plus annual mammogram starting at age 25-30 (Correct answer)
- Biennial mammogram starting at age 45
- Ultrasound only due to dense breast tissue
Correct answer: Annual MRI plus annual mammogram starting at age 25-30
BRCA1 carriers should begin annual breast MRI and mammogram at age 25-30 due to significantly elevated lifetime risk.
Question 2: Which chemoprevention agent is FDA-approved to reduce breast cancer risk in postmenopausal women with atypical hyperplasia?
- Tamoxifen
- Raloxifene
- Anastrozole
- Both tamoxifen and raloxifene (Correct answer)
Correct answer: Both tamoxifen and raloxifene
Both tamoxifen and raloxifene are FDA-approved for breast cancer risk reduction in postmenopausal high-risk women, including those with atypical hyperplasia.
Question 3: A patient presents with Lynch syndrome. Which cancer screening is NOT part of the standard surveillance protocol?
- Annual colonoscopy
- Annual endometrial biopsy for women
- Routine lung CT scan (Correct answer)
- Annual urinalysis for urothelial cancer surveillance
Correct answer: Routine lung CT scan
Lynch syndrome surveillance does not include routine lung CT; it focuses on colorectal, endometrial, urinary tract, and other Lynch-associated cancers.
Question 4: The HPV vaccine is recommended for which age group as primary prevention against cervical cancer?
- Ages 9-12 only
- Ages 9-26, with shared decision-making for ages 27-45 (Correct answer)
- Ages 13-18 only
- Ages 18-45 without restriction
Correct answer: Ages 9-26, with shared decision-making for ages 27-45
HPV vaccine is routinely recommended through age 26; shared clinical decision-making guides vaccination for adults aged 27-45.
Question 5: Which stool-based test for colorectal cancer screening requires annual testing and detects both blood and DNA markers?
- Fecal immunochemical test (FIT)
- Guaiac fecal occult blood test (gFOBT)
- Multi-target stool DNA test (mt-sDNA) (Correct answer)
- Stool culture
Correct answer: Multi-target stool DNA test (mt-sDNA)
The multi-target stool DNA test (Cologuard) detects abnormal DNA and hemoglobin and is recommended every 1-3 years.
Question 6: A 58-year-old man with a 35 pack-year smoking history quit 8 years ago. Should he receive low-dose CT lung cancer screening?
- No, because he quit smoking more than 5 years ago
- Yes, because he meets age and pack-year criteria within the 15-year cessation window (Correct answer)
- Only if he has a first-degree relative with lung cancer
- Only if he has respiratory symptoms
Correct answer: Yes, because he meets age and pack-year criteria within the 15-year cessation window
USPSTF recommends annual LDCT for adults aged 50-80 with a 20 pack-year history who currently smoke or quit within the past 15 years.
Question 7: Which intervention has the strongest evidence for primary prevention of hepatocellular carcinoma (HCC)?
- Annual liver ultrasound surveillance
- Hepatitis B vaccination (Correct answer)
- Low-fat diet and exercise
- Avoidance of raw shellfish
Correct answer: Hepatitis B vaccination
Hepatitis B vaccination is the most effective primary prevention strategy for HCC by preventing chronic HBV infection, the leading cause of HCC worldwide.
AOCNP Cancer Screening and Prevention 4
A 45-year-old woman with BRCA1 mutation asks about breast cancer screening recommendations.
Which protocol is most appropriate?