Breast cancer screening quiz questions
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Breast Cancer Screening — MCQ Quiz (Medical Student / Exam Prep)
Sources: Current Surgical Therapy 14e, Sabiston Textbook of Surgery, Goldman-Cecil Medicine, Grainger & Allison's Diagnostic Radiology
Section 1 — Epidemiology & Burden
Q1. In the United States, breast cancer is:
- A. The most common cancer and the most common cause of cancer death in women
- B. The most commonly diagnosed cancer and the second most common cause of cancer death in women
- C. The second most commonly diagnosed cancer and the leading cause of cancer death in women
- D. The third most commonly diagnosed cancer in women
Answer: B
Breast cancer is the most commonly diagnosed cancer in women in the US and the second most common cause of cancer death (after lung cancer). — Current Surgical Therapy 14e
Q2. A woman in the United States has approximately what lifetime risk of developing breast cancer?
- A. 1 in 4 (25%)
- B. 1 in 6 (17%)
- C. 1 in 8 (12.5%)
- D. 1 in 12 (8%)
Answer: C
A US woman has a 12.3% lifetime risk of developing breast cancer (approximately 1 in 8). — Current Surgical Therapy 14e
Section 2 — Screening Modalities
Q3. Which breast cancer screening modality is the ONLY method shown to decrease breast cancer-related mortality in asymptomatic women?
- A. Breast self-examination
- B. Clinical breast examination
- C. Mammography
- D. Breast MRI
Answer: C
Mammography is the primary imaging screening modality and the only method that has been found to decrease breast cancer–related mortality. — Current Surgical Therapy 14e
Q4. Standard screening mammograms provide how many views of each breast, and what are they?
- A. One view: mediolateral oblique only
- B. Two views: mediolateral oblique and craniocaudal
- C. Three views: mediolateral, craniocaudal, and lateral
- D. Two views: anteroposterior and lateral
Answer: B
Standard mammograms provide two views: the mediolateral oblique (MLO) and the craniocaudal (CC). Using both views allows localization of an abnormality to a specific quadrant and increases sensitivity. — Current Surgical Therapy 14e
Q5. Nine randomized controlled trials of screening mammography (>650,000 women) demonstrated what pooled relative risk reduction for breast cancer mortality?
- A. 10%
- B. 15%
- C. 20%
- D. 35%
Answer: C
With long-term follow-up, pooled RCT results showed a 20% relative risk reduction for breast cancer mortality in women invited to screening. The benefit was most pronounced in the 60–69 year age group. — Current Surgical Therapy 14e
Q6. In randomized trials, screening mammography reduced breast cancer death by approximately what percentage in women aged 60–69?
- A. 14% (RR 0.86)
- B. 15% (RR 0.85)
- C. 20% (RR 0.80)
- D. 32% (RR 0.68)
Answer: D
Two trials that included women aged 60–69 showed a 32% reduction in breast cancer death (RR 0.68, CrI 0.54–0.87). — Sabiston Textbook of Surgery
Q7. Breast self-examination (BSE) as a routine screening tool:
- A. Reduces breast cancer–specific mortality in average-risk populations
- B. Reduces all-cause mortality in average-risk populations
- C. Has NOT been shown to reduce breast cancer or all-cause mortality in large randomized trials
- D. Is strongly recommended by all major guidelines
Answer: C
Large randomized trials have failed to show a reduction in breast cancer–specific or all-cause mortality from regular BSE in average-risk populations. It is now de-emphasized in guidelines. — Current Surgical Therapy 14e
Q8. Clinical breast examination (CBE) is reported to detect approximately what proportion of breast cancers not visible on screening mammography?
- A. 1–5%
- B. 5–8%
- C. 10–20%
- D. 25–30%
Answer: C
About 10–20% of breast cancers are not visible on screening mammography; CBE performed by trained personnel has been shown to increase detection over mammography alone. — Current Surgical Therapy 14e
Q9. The false-positive rate of CBE is approximately how many false positives per additional cancer detected?
- A. 5
- B. 15
- C. 30
- D. 55
Answer: D
There may be as many as 55 false-positive CBE findings for each additional cancer detected by CBE — a major limitation of this modality. — Current Surgical Therapy 14e
Section 3 — BI-RADS Classification
Q10. A mammogram classified as BI-RADS 0 requires:
- A. Routine annual screening
- B. Short-interval follow-up at 6 months
- C. Tissue diagnosis (biopsy)
- D. Additional imaging or prior examinations before a final assessment can be made
Answer: D
BI-RADS 0 = incomplete/need additional imaging or comparison with prior examinations. — Current Surgical Therapy 14e
Q11. A BI-RADS 3 mammographic finding carries what approximate likelihood of malignancy, and what is the recommended management?
- A. Essentially 0%; routine screening
- B. >0% but <2%; short-interval follow-up (6 months)
- C. 2–10%; tissue diagnosis
- D. 10–50%; tissue diagnosis
Answer: B
BI-RADS 3 = probably benign, likelihood of cancer >0% but <2%, management is short-interval follow-up at 6 months. — Current Surgical Therapy 14e
Q12. Which BI-RADS category carries a ≥95% likelihood of malignancy?
- A. BI-RADS 4c
- B. BI-RADS 5
- C. BI-RADS 6
- D. BI-RADS 4b
Answer: B
BI-RADS 5 = highly suggestive of malignancy, likelihood ≥95%; management is tissue diagnosis. BI-RADS 6 is reserved for known biopsy-proven malignancy. — Current Surgical Therapy 14e
Q13. A BI-RADS 4b finding carries what probability of malignancy?
- A. >2% to ≤10%
- B. >10% to ≤50%
- C. >50% to <95%
- D. ≥95%
Answer: B
BI-RADS 4 is subdivided: 4a = >2% to ≤10% (low suspicion), 4b = >10% to ≤50% (moderate suspicion), 4c = >50% to <95% (high suspicion). — Current Surgical Therapy 14e
Section 4 — Screening Guidelines (Average Risk)
Q14. According to the American Cancer Society (ACS), at what age should annual screening mammography be strongly recommended for average-risk women?
- A. 40 years
- B. 45 years
- C. 50 years
- D. 55 years
Answer: B
The ACS recommends annual mammography beginning at age 45 for average-risk women, with the option to begin at age 40–44 based on individual preference and risk-benefit discussion. — Current Surgical Therapy 14e
Q15. According to the USPSTF (2024 update), screening mammography should be offered to average-risk women beginning at age:
- A. 40
- B. 45
- C. 50
- D. 55
Answer: A
The USPSTF recommends that all women with average risk begin screening mammography at age 40, with biennial screening. Prior to the 2024 update the recommendation was individual decision before age 50, with biennial screening from 50–74. — Goldman-Cecil Medicine; Sabiston Textbook of Surgery
Q16. The ACS recommends which screening interval for average-risk women aged ≥55 years?
- A. Annual only
- B. Every 3 years
- C. Annual or biennial (every 2 years), with annual preferred
- D. Every 5 years
Answer: C
ACS: Women ≥55 may transition to biennial (or continue annual) screening, as long as they are in good health with a life expectancy ≥10 years. — Current Surgical Therapy 14e; Goldman-Cecil Medicine
Q17. The NCCN recommends that women undergo a breast cancer risk assessment by what age?
- A. 18 years
- B. 21 years
- C. 25 years
- D. 30 years
Answer: C
NCCN guidelines recommend breast cancer risk assessment by age 25, with guidance on potential risks and benefits of screening according to risk level. — Current Surgical Therapy 14e
Q18. According to NCCN guidelines, clinical breast examination should be performed at what frequency for average-risk women aged 25–40?
- A. Annually
- B. Every 6 months
- C. Every 1–3 years
- D. Only at age 40
Answer: C
NCCN recommends clinical encounter/examination every 1–3 years from age 25–40, then annually from age 40 onwards. — Sabiston Textbook of Surgery
Section 5 — High-Risk Screening
Q19. Supplemental annual breast MRI is recommended in addition to mammography for women whose lifetime risk of breast cancer exceeds:
- A. 10%
- B. 15%
- C. 20%
- D. 25%
Answer: C
Annual breast MRI is recommended for women with a predicted lifetime risk >20% (models largely dependent on family history), for BRCA carriers, and for other specified high-risk groups. — Current Surgical Therapy 14e
Q20. In a woman with a deleterious BRCA mutation, at what age should annual screening breast MRI begin according to NCCN guidelines?
- A. 20 years
- B. 25 years
- C. 30 years
- D. 35 years
Answer: B
NCCN: For BRCA mutation carriers, annual breast MRI begins at age 25; annual mammography begins at age 30. — Current Surgical Therapy 14e
Q21. A woman received thoracic radiation therapy at age 22. According to guidelines, screening mammography and breast MRI should begin:
- A. Immediately
- B. 5 years after radiation therapy, but not before age 25
- C. 8 years after radiation therapy, but not before age 25 (MRI) and age 30 (mammography)
- D. At age 40 regardless of radiation history
Answer: C
For thoracic RT between ages 10 and 30: screening MRI begins 8 years after RT (not before age 25) and screening mammography begins 8 years after RT (not before age 30). — Current Surgical Therapy 14e
Q22. Breast MRI screening is NOT recommended for women with a lifetime breast cancer risk of:
- A. >20%
- B. Known BRCA mutation
- C. <15%
- D. Li Fraumeni syndrome
Answer: C
Screening MRI is not recommended for women with a lifetime risk <15%. Evidence is also insufficient for women with lifetime risk 15–20%. — Current Surgical Therapy 14e
Q23. Which of the following syndromes is specifically listed in NCCN guidelines as an indication to begin annual breast MRI screening?
- A. Lynch syndrome
- B. Li Fraumeni syndrome
- C. Multiple endocrine neoplasia type 1
- D. Von Hippel-Lindau syndrome
Answer: B
NCCN includes Li Fraumeni syndrome (and Cowden's syndrome) as indications for enhanced screening with annual breast MRI. — Current Surgical Therapy 14e
Q24. In a woman with ≥20% lifetime risk whose youngest affected family member was diagnosed at age 38, at what age should supplemental MRI screening ideally begin?
- A. Age 25
- B. Age 28 (10 years before family member's diagnosis at 38)
- C. Age 30
- D. Age 35
Answer: B
MRI screening should begin 10 years before the youngest family member's diagnosis (38 − 10 = 28), but not before age 25. Since 28 > 25, screening begins at age 28. — Current Surgical Therapy 14e
Section 6 — Breast Density & Supplemental Imaging
Q25. Compared to women with average breast density, women with extremely dense breasts have approximately what increased relative risk of developing breast cancer?
- A. 1.2-fold
- B. 2.1-fold
- C. 4- to 6-fold
- D. 10-fold
Answer: C
Studies comparing women with the highest density (extremely dense) to those with the lowest density show a 4- to 6-fold increase in risk. Women with heterogeneously dense breasts have a 1.2-fold increase, and those with extremely dense breasts have a 2.1-fold increase relative to average density. — Current Surgical Therapy 14e
Q26. Breast density is associated with which of the following?
- A. Lower sensitivity of screening mammography only
- B. Higher sensitivity of screening mammography
- C. Lower sensitivity of mammography AND is an independent risk factor for breast cancer
- D. Higher mortality from breast cancer once diagnosed
Answer: C
Breast density is associated with lower mammographic sensitivity AND is an independent risk factor for breast cancer. However, breast density is NOT associated with increased mortality from breast cancer once diagnosed. — Current Surgical Therapy 14e
Q27. Supplemental imaging modalities added to screening mammography detect approximately how many additional cancers per 1000 exams?
- A. 1–2
- B. 3–4
- C. ~5
- D. 10–15
Answer: C
The addition of supplemental modalities (MRI, ultrasound) increases the breast cancer detection rate by about 5 additional cancers per 1000 exams, but comes with a >10% recall rate and increased biopsy rate. — Sabiston Textbook of Surgery
Section 7 — Digital Breast Tomosynthesis (DBT)
Q28. Digital breast tomosynthesis (DBT) compared to standard 2D mammography has been shown to:
- A. Decrease cancer detection rates but improve specificity
- B. Increase cancer detection rates by approximately 31–43% in European prospective trials
- C. Have no significant effect on recall rates
- D. Decrease cancer detection rates
Answer: B
Four European prospective trials of DBT showed an increase in cancer detection ranging from 31% to 43%. The effect on recall rates varied across settings. — Grainger & Allison's Diagnostic Radiology
Q29. In the large US time-series analysis by Friedewald et al (2014) introducing DBT across 13 centres, cancer detection rate increased from 4.2 to how many per 1000 women screened?
- A. 4.8 per 1000
- B. 5.4 per 1000
- C. 6.1 per 1000
- D. 7.0 per 1000
Answer: B
DBT screening showed an increase in cancer detection from 4.2 to 5.4 per 1000 women screened (a 29% increase), while recall rates fell from 10.7% to 9.1%. — Grainger & Allison's Diagnostic Radiology
Q30. DBT is particularly effective at detecting which type of mammographic finding?
- A. Microcalcifications
- B. Skin thickening
- C. Spiculate lesions and architectural distortions
- D. Peau d'orange
Answer: C
DBT is particularly good at picking up spiculate lesions and architectural distortions, which can be associated with lower histological grade tumours. — Grainger & Allison's Diagnostic Radiology
Section 8 — UK Screening Programme
Q31. The UK NHS Breast Screening Programme was established following which report?
- A. The Marmot Report (2012)
- B. The Forrest Report (1988)
- C. The Wilson-Jungner criteria (1968)
- D. The Cochrane Review (2001)
Answer: B
The NHSBSP was set up in 1988 following the Forrest Report, commissioned by the UK Department of Health. It was the first population-based breast screening programme in the world. — Grainger & Allison's Diagnostic Radiology
Q32. In the UK NHS Breast Screening Programme, women between what ages are routinely invited every 3 years?
- A. 40–65 years
- B. 45–70 years
- C. 50–70 years
- D. 55–75 years
Answer: C
Women aged 50–70 are invited every 3 years for two-view mammography with double reading. Women over 70 are not invited but may attend by self-referral. — Grainger & Allison's Diagnostic Radiology
Q33. The Marmot Review (2012) concluded that for 10,000 UK women invited for screening over 20 years from age 50, approximately how many breast cancer deaths would be prevented?
- A. 15
- B. 43
- C. 129
- D. 200
Answer: B
The Marmot panel estimated 43 deaths from breast cancer would be prevented per 10,000 women invited, alongside 129 cases of overdiagnosis. The panel concluded the benefits outweighed the harms. — Grainger & Allison's Diagnostic Radiology
Q34. According to the Marmot Review, what proportion of cancers detected in the UK screening programme represent overdiagnosis?
- A. 1 in 10 detected cancers
- B. 1 in 5 detected cancers (approximately 129/681)
- C. 1 in 3 detected cancers
- D. 1 in 2 detected cancers
Answer: B
Of 681 cancers detected per 10,000 women screened, 129 represent overdiagnosis — approximately 1 in 5 (19%). — Grainger & Allison's Diagnostic Radiology
Section 9 — Harms of Screening & Overdiagnosis
Q35. Which of the following is NOT a recognized potential harm of breast cancer screening?
- A. Radiation exposure from mammography
- B. False-positive imaging leading to additional workup and biopsy
- C. Overdiagnosis of indolent tumours
- D. Increased rate of metastatic breast cancer at presentation
Answer: D
Recognized harms include radiation exposure, false-positive findings (additional imaging, biopsy, anxiety, cost), and overdiagnosis of low-grade/non-aggressive tumours. Screening does not increase the rate of metastatic presentation. — Current Surgical Therapy 14e
Q36. Approximately what proportion of cancers detected by mammographic screening are ductal carcinoma in situ (DCIS)?
- A. 5%
- B. 10–15%
- C. 25%
- D. 40–50%
Answer: C
Approximately 25% of cancers detected by mammographic screening are DCIS. High-grade DCIS is accepted as a precursor to high-grade invasive disease; detection of low-grade DCIS is more controversial. — Grainger & Allison's Diagnostic Radiology
Q37. Of low-grade DCIS detected at screening, approximately what proportion will eventually develop into low-grade invasive breast cancer?
- A. 10%
- B. 25%
- C. 40%
- D. 70%
Answer: C
Only approximately 40% of cases of low-grade DCIS will eventually develop low-grade invasive breast cancer, making the benefit of detecting it more controversial. — Grainger & Allison's Diagnostic Radiology
Section 10 — Chemoprevention (Closely Linked to Screening)
Q38. Tamoxifen (20 mg/day) reduces the risk of invasive breast cancer by approximately what percentage in high-risk women?
- A. 15%
- B. 25%
- C. 40%
- D. 60%
Answer: C
Tamoxifen reduces the risk of invasive breast cancer by about 40% in high-risk women (age ≥60, diagnosis of LCIS, or ages 35–59 with ≥1.67% 5-year risk). — Goldman-Cecil Medicine
Q39. Which of the following statements about raloxifene vs. tamoxifen for breast cancer chemoprevention is CORRECT?
- A. Raloxifene is more effective than tamoxifen at preventing invasive breast cancer in high-risk postmenopausal women
- B. Raloxifene is equally effective and has fewer uterine cancers but the same thromboembolic risk as tamoxifen
- C. Raloxifene has more uterine cancers but fewer thromboembolic events than tamoxifen
- D. Both agents are effective and recommended for premenopausal women
Answer: B
Raloxifene is less effective than tamoxifen for preventing invasive breast cancer in high-risk postmenopausal women, but is associated with fewer uterine cancers with the same thromboembolic risk. — Goldman-Cecil Medicine
Q40. Prophylactic mastectomy reduces the risk of developing breast cancer in high-risk individuals (strong family history or BRCA mutation) by approximately:
- A. 40–50%
- B. 60–70%
- C. 90%
- D. 100%
Answer: C
Prophylactic mastectomy reduces breast cancer risk by approximately 90% in high-risk individuals; however, women must be counselled that cancer can develop in remnants of breast tissue that persist. — Goldman-Cecil Medicine
Section 11 — Biopsy Techniques
Q41. Which percutaneous biopsy technique is generally PREFERRED over fine-needle aspiration (FNA) for breast lesions, and why?
- A. Core needle biopsy, because it preserves architecture and allows marker analysis/immunohistochemistry
- B. FNA, because it is more sensitive
- C. Vacuum-assisted biopsy only, because core needle is insufficient
- D. Open surgical biopsy, as it is the gold standard for all lesions
Answer: A
Core needle biopsy (or vacuum-assisted device) is preferred over FNA for all breast lesions because of increased sensitivity and preservation of architecture, allowing characterization with marker analysis and immunohistochemistry. — Current Surgical Therapy 14e
Q42. For lesions that are visible sonographically, which image guidance is PREFERRED for biopsy?
- A. Stereotactic (mammographic) guidance
- B. MRI guidance
- C. Ultrasound guidance
- D. No image guidance needed for palpable lesions
Answer: C
If a lesion is visible sonographically, ultrasound guidance is preferred as it optimises patient positioning and comfort. Stereotactic guidance is preferred for lesions better seen on mammography (particularly microcalcifications). — Current Surgical Therapy 14e
References:
- Current Surgical Therapy, 14th Edition — Chapter: Screening for Breast Cancer
- Sabiston Textbook of Surgery — Chapter 68: Breast Imaging and Diagnostic Biopsy
- Goldman-Cecil Medicine, International Edition — Chapter 183: Breast Cancer Screening Table & Chemoprevention
- Grainger & Allison's Diagnostic Radiology — Chapter 63: Breast Cancer Screening Programmes & DBT
CIN 1 follow up regimen
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CIN 1 cervical intraepithelial neoplasia management follow-up
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ASCCP 2019 guidelines CIN 1 follow up management algorithm
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CIN 1 Follow-Up Regimen
What is CIN 1?
CIN 1 (low-grade cervical intraepithelial neoplasia) is a histopathologic manifestation of HPV infection, not a true cancer precursor. It corresponds cytologically to a low-grade squamous intraepithelial lesion (LSIL). The spontaneous regression rate is conservatively estimated at 60–85% in prospective studies, with regression typically occurring within 2 years. — Berek & Novak's Gynecology
Standard Follow-Up (Average-Risk Adult Women ≥25 years)
Biopsy-proven CIN 1 preceded by ASC-US or LSIL cytology + satisfactory colposcopy:
| Time Point | Action |
|---|---|
| 12 months | Co-testing: cytology + high-risk HPV testing |
| If both negative at 12 months | Return to routine age-appropriate screening |
| If either abnormal at 12 months | Return to colposcopy for re-evaluation |
The cornerstone of management is surveillance (not treatment). Treatment (ablation or excision) is not indicated for initial CIN 1.
Higher-Risk Scenario: CIN 1 Preceded by ASC-H or HSIL Cytology
When biopsy shows CIN 1 but the preceding cytology was ASC-H (atypical squamous cells, cannot exclude high-grade) or HSIL, the clinical risk is elevated. Two acceptable options:
- Co-testing at 12 and 24 months (cytology + high-risk HPV), OR
- Loop electrosurgical excision procedure (LEEP) — may be appropriate given the higher-risk cytologic–histologic discordance
The discordance between high-grade cytology and low-grade histology may indicate sampling error or a missed higher-grade lesion.
Special Populations
Women aged 21–24 years
- Cytology-only surveillance (no HPV co-testing) at 12 and 24 months
- Referral back to colposcopy only if ASC-US or greater on repeat cytology
- More conservative approach due to the very high spontaneous regression rate in this age group and to avoid over-treatment
Pregnant Women
- No treatment for CIN 1 during pregnancy
- Follow with cytology and colposcopy; reassess at 6 weeks postpartum
Immunocompromised Women (HIV+, post-transplant)
- Generally require more aggressive follow-up and management
- Colposcopy is recommended when there is concern for severe or malignant changes
Persistent CIN 1 (≥2 years)
When CIN 1 persists after 2 or more years of surveillance, options include:
- Continued observation, or
- Treatment (ablation or excision) — acceptable if the transformation zone is fully visible, no endocervical involvement, and colposcopy is adequate
Key Principles Summary
| Principle | Detail |
|---|---|
| CIN 1 nature | HPV infection manifestation, NOT a precancer |
| Regression rate | 60–85% within 2 years |
| First-line management | Surveillance — NOT immediate treatment |
| Standard co-testing interval | 12 months |
| Return to routine screening | After negative co-test at 12 months |
| ASC-H/HSIL preceded CIN 1 | Co-test at 12 & 24 months OR consider LEEP |
| Ages 21–24 | Cytology alone at 12 & 24 months |
| Treatment threshold | Only if persistent ≥2 years or high-risk scenario |
Source: Berek & Novak's Gynecology — Chapter 16: Cervical Intraepithelial Neoplasia; based on ASCCP/NCI 2012 Consensus Guidelines (updated algorithms available at asccp.org).
Note: The 2019 ASCCP risk-based management guidelines introduced a shift from algorithm-based to individualized risk-stratified follow-up using cumulative CIN 3+ risk estimates. Under the 2019 guidelines, the threshold for recommending colposcopy, treatment, or surveillance is based on calculated risk (immediate and 5-year risk for CIN 3+) rather than a single test result. The textbook content above reflects the 2012 framework. In clinical practice, consult the current ASCCP app/guidelines at asccp.org for the most up-to-date risk-based thresholds.
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