Breast Cancer Screening — 15 MCQs (Specialist Level)

• A) 40
• B) 45
• C) 50 ✓
• D) 55

The 2024 USPSTF recommends biennial mammography starting at age 50 for average-risk women, with individual decision-making before age 50. (USPSTF 2024, PMID: 38687503; Goldman-Cecil Medicine)

• A) 40
• B) 45 ✓
• C) 50
• D) 55

ACS recommends annual screening from age 45, with an option to begin at 40, transitioning to biennial at 55 if the patient prefers. (Goldman-Cecil Medicine, Table 183-6)

• A) BI-RADS 2
• B) BI-RADS 3
• C) BI-RADS 4 ✓
• D) BI-RADS 1

BI-RADS 4 (suspicious) carries a 2–95% probability of malignancy and warrants tissue sampling. BI-RADS 3 (probably benign) carries <2% risk and warrants 6-month follow-up imaging, not immediate biopsy. (Current Surgical Therapy 14e)

• A) Decreased cancer detection rate
• B) No change in recall rate
• C) Increased cancer detection rate ✓
• D) Reduced radiation dose

All four major European prospective trials showed DBT increased cancer detection rates by 31–43% (from ~5–6 to ~8–9 per 1,000). The effect on recall rates varied between studies. (Grainger & Allison's Diagnostic Radiology)

• A) Mammography annually starting at age 40
• B) Annual breast MRI plus mammography, starting 10 years before the youngest family member's age at diagnosis ✓
• C) Mammography every 2 years starting now
• D) Breast MRI alone, without mammography

Women with ≥20% lifetime risk should receive annual MRI + mammography, beginning 10 years before the earliest familial diagnosis. (Current Surgical Therapy 14e)

• A) Start at age 40 with annual mammography
• B) Start immediately with MRI annually
• C) Annual MRI and mammography beginning 8 years after thoracic radiotherapy ✓
• D) No supplemental screening recommended

Women who received thoracic radiotherapy between ages 10–30 should begin annual MRI + mammography 8 years after radiotherapy. (Current Surgical Therapy 14e)

• A) Radiation-induced carcinogenesis
• B) Procedure-related haematoma
• C) Diagnosis and treatment of indolent tumours unlikely to affect survival ✓
• D) Contrast nephropathy from MRI

Overdiagnosis — detecting cancers (particularly low-grade DCIS and slow-growing invasive tumours) that would never have caused symptoms or death — is the principal long-term harm of screening. Estimates range from 3.3% for invasive cancer to 18–32% for DCIS. (Goldman-Cecil Medicine; Current Surgical Therapy 14e)

• A) It is technically impossible for women to perform
• B) It increases rates of unnecessary imaging
• C) Large randomised trials showed no reduction in breast cancer mortality from routine BSE ✓
• D) It is associated with increased anxiety but no effect on detection

RCTs have failed to demonstrate mortality benefit from routine BSE in average-risk populations. It remains low-cost and may prompt patients to report interval changes but is no longer actively recommended. (Current Surgical Therapy 14e)

• A) Annually
• B) Every 3 years ✓
• C) Every 2 years
• D) Every 5 years

The UK NHSBSP invites women aged 50–70 every 3 years for two-view mammography with double reading — the first population-based programme of its kind globally, established in 1988. (Grainger & Allison's Diagnostic Radiology)

• A) Microcalcification clusters
• B) Skin thickening
• C) Spiculate masses and architectural distortions ✓
• D) Lymph node enlargement

DBT is especially sensitive for detecting spiculate lesions and architectural distortions, which can be obscured by overlapping fibroglandular tissue on standard 2D mammography. (Grainger & Allison's Diagnostic Radiology)

• A) Additional mammographic views only
• B) Whole-breast ultrasound annually
• C) No change from standard mammography
• D) Annual breast MRI in addition to mammography ✓

Women with lobular neoplasia (LCIS/ALH) or ADH and ≥20% lifetime risk are candidates for annual breast MRI as an adjunct to mammography. (Current Surgical Therapy 14e)

• A) 5
• B) 15
• C) 55 ✓
• D) 100

Studies suggest approximately 55 false-positive CBE findings for each additional cancer detected by CBE beyond mammography — a key reason for its reduced emphasis in current guidelines. (Current Surgical Therapy 14e)

• A) Mandatory discontinuation at age 75
• B) Continue biennial mammography indefinitely
• C) Switch to MRI only
• D) Individualise based on overall health and estimated life expectancy ✓

There is no universally agreed upper age limit for screening. USPSTF notes insufficient evidence for women ≥75 years. Both ACS and NCCN recommend individualising the decision based on health status and life expectancy (generally continuing if >10 years is anticipated). (Goldman-Cecil Medicine; Current Surgical Therapy 14e)

• A) Significantly less favourable; screening not indicated
• B) Equivalent to average-risk women aged 40–49
• C) Similar to average-risk women aged 50–74 ✓
• D) More favourable than women over 75

Women aged 40–49 with a twofold increased risk have a benefit-to-harm ratio for biennial screening that approximates that of average-risk women aged 50–74 — supporting earlier initiation of screening in this group. (Goldman-Cecil Medicine)

• A) Raised the recommended starting age from 40 to 50
• B) Endorsed annual over biennial screening for all ages
• C) Recommended against screening for women under 50
• D) Lowered the recommended starting age from 50 to 40, recommending biennial screening from age 40 ✓

The 2024 USPSTF update represents a major change: it now recommends biennial mammography starting at age 40 (previously individual decision before 50), reflecting updated modelling showing mortality reductions across all age groups from 40 onward. (USPSTF 2024, PMID: 38687503)

Summary Table