AOCNP Cancer Screening and Prevention 5 — Questions and Answers
Question 1: A 70-year-old woman asks about cervical cancer screening. Which recommendation is most appropriate for an average-risk woman her age?
- Continue annual Pap smears indefinitely
- Discontinue screening if she has had adequate prior screening with no abnormal results (Correct answer)
- Switch to HPV co-testing every 3 years
- Begin colposcopy surveillance annually
Correct answer: Discontinue screening if she has had adequate prior screening with no abnormal results
Women aged 65 and older with adequate prior negative screening can discontinue cervical cancer screening per USPSTF guidelines.
Question 2: Which modifiable risk factor has the strongest evidence for reducing colorectal cancer incidence?
- Increasing dietary fiber intake
- Regular physical activity and maintaining healthy weight (Correct answer)
- Avoiding red meat entirely
- Taking daily vitamin D supplements
Correct answer: Regular physical activity and maintaining healthy weight
Regular physical activity and maintaining a healthy body weight have the strongest evidence for reducing colorectal cancer risk among modifiable lifestyle factors.
Question 3: A patient with Li-Fraumeni syndrome (TP53 germline mutation) should avoid which imaging modality for surveillance when possible?
- MRI
- Ultrasound
- Ionizing radiation (CT and X-ray) (Correct answer)
- PET scan
Correct answer: Ionizing radiation (CT and X-ray)
Patients with Li-Fraumeni syndrome have impaired DNA repair and are especially susceptible to radiation-induced cancers, so ionizing radiation should be minimized.
Question 4: Aspirin is being studied as a chemopreventive agent for colorectal cancer. Which patient characteristic most strongly supports its use in this context?
- Age over 70 with average risk
- Lynch syndrome with prior colorectal polyps (Correct answer)
- Family history of sporadic colon cancer only
- Current smoker with inflammatory bowel disease
Correct answer: Lynch syndrome with prior colorectal polyps
Patients with Lynch syndrome have shown significant colorectal cancer risk reduction with aspirin use in clinical trials such as CAPP2.
Question 5: Which screening tool is recommended by the American Cancer Society for early detection of prostate cancer in high-risk men (African American or first-degree relative with prostate cancer before age 65)?
- Annual DRE starting at age 40
- PSA discussion and shared decision-making starting at age 40 (Correct answer)
- Annual PSA without discussion starting at age 45
- Transrectal ultrasound annually starting at age 45
Correct answer: PSA discussion and shared decision-making starting at age 40
High-risk men should have a shared decision-making conversation about PSA-based prostate cancer screening starting at age 40.
Question 6: A nurse practitioner is counseling a patient on skin cancer prevention. Which UV exposure recommendation is supported by the strongest evidence?
- Avoid sun between 10 AM and 4 PM and use broad-spectrum SPF 30+ sunscreen (Correct answer)
- Use SPF 15 sunscreen daily and get annual tanning booth sessions for vitamin D
- Avoid sunscreen as it blocks vitamin D synthesis
- Sun exposure before 8 AM is safe and adequate for vitamin D without cancer risk
Correct answer: Avoid sun between 10 AM and 4 PM and use broad-spectrum SPF 30+ sunscreen
Avoiding peak UV hours (10 AM–4 PM) and using broad-spectrum SPF 30+ sunscreen are the core evidence-based recommendations for skin cancer prevention.
Question 7: Which finding on a lung cancer screening LDCT result would prompt immediate further workup rather than routine annual follow-up?
- A 4 mm solid nodule
- A 7 mm part-solid nodule with solid component greater than 6 mm (Correct answer)
- A 3 mm ground-glass nodule
- Two calcified granulomas
Correct answer: A 7 mm part-solid nodule with solid component greater than 6 mm
Per Lung-RADS, a part-solid nodule with solid component >6 mm is classified as Lung-RADS 4B requiring tissue sampling or PET/CT, not routine follow-up.
AOCNP Cancer Screening and Prevention 5
A 70-year-old woman asks about cervical cancer screening.
Which recommendation is most appropriate for an average-risk woman her age?