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CBCN practice questions

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Question 1Breast Health and Risk Assessment

Approximately how many lobes make up each adult female breast?

  1. 50 to 60
  2. 30 to 40
  3. 15 to 20 Correct answer.
  4. 4 to 6

Explanation

The mature female breast contains roughly 15 to 20 lobes of glandular tissue, each drained by its own lactiferous duct that opens at the nipple. This lobar architecture explains why a single ductal system can be affected in isolation by disease.

Question 2Breast Health and Risk Assessment

The portion of breast tissue that extends laterally toward the axilla along the lower edge of the pectoralis major is called the:

  1. Suspensory fascia
  2. Tail of Spence Correct answer.
  3. Cooper ligament
  4. Montgomery tubercle

Explanation

The axillary extension of glandular tissue is the tail of Spence, and it is a common site for missed cancers because it lies outside the typical mammographic field. Cooper ligaments are the fibrous bands supporting the breast, and Montgomery tubercles are the sebaceous glands of the areola.

Question 3Breast Health and Risk Assessment

Which single factor is the strongest predictor of breast cancer risk in women?

  1. Early menarche
  2. Advancing age Correct answer.
  3. Nulliparity
  4. Family history of breast cancer

Explanation

Incidence rises steadily with age, making advancing age the strongest single risk factor; most breast cancers occur in women without any family history. Reproductive factors such as early menarche and nulliparity raise risk modestly by comparison.

Question 4Breast Health and Risk Assessment

A 24-year-old notices a firm, rubbery, very mobile 2-cm mass in the upper outer quadrant. She has no nipple discharge and no skin changes. What is the most likely diagnosis?

  1. Fibroadenoma Correct answer.
  2. Fat necrosis
  3. Inflammatory breast cancer
  4. Phyllodes tumor

Explanation

A well-circumscribed, rubbery, highly mobile mass in a woman in her twenties is characteristic of a fibroadenoma, the most common benign solid breast tumor. Malignancy is uncommon at this age, and inflammatory cancer presents with skin changes rather than a mobile discrete mass.

Question 5Breast Health and Risk Assessment

According to the American Cancer Society, at what age should women at average risk begin annual screening mammography?

  1. 50
  2. 35
  3. 40 Correct answer.
  4. 30

Explanation

The ACS recommends annual mammography beginning at age 40 for women at average risk, with a transition to biennial screening or continued annual screening at 55. Other organizations differ, which is why identifying the source guideline matters when counseling patients.

Question 6Breast Health and Risk Assessment

Which statement best reflects current evidence about breast self-examination (BSE)?

  1. BSE should replace clinical breast examination in low-resource areas
  2. BSE has not lowered mortality; breast self-awareness is favored Correct answer.
  3. Monthly BSE lowers breast cancer mortality in all age groups
  4. BSE detects more cancers than mammography does in women over 50

Explanation

Large trials found no mortality benefit from structured monthly BSE, and it increases benign biopsy rates, so guidelines now promote breast self-awareness instead. Self-awareness means knowing one's normal appearance and texture and reporting persistent changes.

Question 7Breast Health and Risk Assessment

What is the most common presenting sign of male breast cancer?

  1. Painless subareolar mass Correct answer.
  2. Bloody nipple discharge as the sole finding
  3. Peau d'orange of the entire breast
  4. Bilateral diffuse breast thickening

Explanation

Male breast cancer most often appears as a painless, firm subareolar lump because male breast tissue is concentrated centrally around the duct system. Nipple discharge and skin changes can occur but are less typical presenting findings.

Question 8Breast Health and Risk Assessment

A mammogram is assigned BI-RADS category 3. What does this mean?

  1. Probably benign; short-interval follow-up Correct answer.
  2. Incomplete; additional imaging needed
  3. Negative; return to routine screening
  4. Highly suggestive of malignancy; biopsy now

Explanation

BI-RADS 3 means the finding is probably benign, with a likelihood of malignancy under about 2 percent, and the standard recommendation is short-interval follow-up rather than biopsy. Categories 4 and 5 carry sufficient suspicion to warrant tissue sampling.

Question 9Breast Health and Risk Assessment

BRCA1 and BRCA2 pathogenic variants are inherited in which pattern?

  1. Autosomal dominant Correct answer.
  2. Autosomal recessive
  3. Mitochondrial
  4. X-linked dominant

Explanation

BRCA variants are inherited in an autosomal dominant pattern with incomplete penetrance, so a parent of either sex can pass the variant to sons or daughters. A first-degree relative carrying the variant confers up to a 50 percent chance of inheritance.

Question 10Breast Health and Risk Assessment

Which statement about lobular carcinoma in situ (LCIS) is accurate?

  1. It raises risk in both breasts and is a risk marker Correct answer.
  2. It is a direct precursor requiring mastectomy
  3. It usually presents as a palpable mass
  4. It is more common after menopause than before

Explanation

LCIS is regarded as a marker of increased risk across both breasts rather than a direct precursor lesion, so management centers on surveillance and risk reduction rather than mastectomy. It is typically an incidental microscopic finding in women before menopause.

Question 11Breast Health and Risk Assessment

A core biopsy shows atypical ductal hyperplasia. How does this change the patient's breast cancer risk?

  1. It raises risk only slightly, about 1.1-fold
  2. It raises risk about 20-fold
  3. It does not change risk
  4. It raises risk roughly 4 to 5 times Correct answer.

Explanation

Atypical ductal hyperplasia is a proliferative lesion with atypia and confers a relative risk of about four to five times that of the general population. This places it in the high-risk category where enhanced screening and chemoprevention discussions are appropriate.

Question 12Breast Health and Risk Assessment

Which factor is included in the Gail (BCRAT) breast cancer risk model?

  1. Age at natural menopause
  2. Mammographic density (percent dense tissue)
  3. Number of prior breast biopsies Correct answer.
  4. BRCA1 or BRCA2 mutation status

Explanation

The Gail model incorporates age, age at menarche, age at first live birth, number of first-degree relatives with breast cancer, number of prior breast biopsies, and presence of atypia on biopsy. It does not incorporate genetic mutation status, breast density, or age at menopause.

Question 13Breast Health and Risk Assessment

Why is dense breast tissue on mammography clinically important?

  1. It reduces the need for additional imaging
  2. It lowers overall breast cancer risk
  3. It guarantees that any mass found is benign
  4. It masks tumors and independently raises risk Correct answer.

Explanation

Dense tissue appears white on mammography and can obscure tumors, and density is also an independent risk factor for breast cancer. This combination is why supplemental screening may be discussed for women with very dense breasts.

Question 14Breast Health and Risk Assessment

Use of combined estrogen-plus-progestin hormone therapy for five or more years is associated with which outcome?

  1. No measurable effect on breast tissue
  2. Higher breast cancer risk and later-stage diagnosis Correct answer.
  3. Reduced mammographic density
  4. Reduced breast cancer risk

Explanation

The Women's Health Initiative showed that combined estrogen-plus-progestin therapy increases breast cancer incidence and is linked to larger, later-stage tumors, likely because it also increases breast density. Estrogen-alone therapy in women with a prior hysterectomy has a different, less adverse profile.

Question 15Breast Health and Risk Assessment

What is the established relationship between alcohol intake and breast cancer risk?

  1. Risk applies only to women with a family history
  2. Beer is protective compared with wine
  3. Risk rises with each additional daily drink Correct answer.
  4. Risk is unchanged until three drinks daily

Explanation

Alcohol shows a dose-response relationship with breast cancer risk: even one drink per day is associated with a modest increase, and risk climbs with each additional drink. The type of alcohol does not appear to matter.

Question 16Breast Health and Risk Assessment

Which set of findings most suggests inflammatory breast cancer?

  1. Cyclic bilateral tenderness that eases after menses
  2. A single duct discharging milky fluid when expressed
  3. Rapid erythema and peau d'orange without a mass Correct answer.
  4. A freely mobile mass with smooth, well-defined borders

Explanation

Inflammatory breast cancer presents with rapid onset of diffuse erythema, warmth, edema, and peau d'orange, often without a discrete mass because tumor cells block dermal lymphatics. Delay in recognition is common because it mimics mastitis.

Question 17Breast Health and Risk Assessment

Paget disease of the nipple most typically presents as:

  1. An eczema-like, scaling, itching nipple lesion Correct answer.
  2. A painful blue nodule beneath the areola
  3. Clear discharge from multiple ducts
  4. Bilateral nipple inversion present since menarche

Explanation

Paget disease produces a unilateral, eczema-like change of the nipple and areola that persists despite topical treatment and is often associated with underlying ductal carcinoma in situ or invasive cancer. Any persistent unilateral nipple rash warrants biopsy.

Question 18Breast Health and Risk Assessment

Which nipple discharge characteristic is most concerning for underlying malignancy?

  1. Greenish and coming from multiple ducts
  2. Bilateral, milky, and easily expressed
  3. Clear and produced only with squeezing
  4. Unilateral, spontaneous, bloody, from a single duct Correct answer.

Explanation

Discharge that is unilateral, spontaneous, bloody or serous, and confined to one duct is the pattern most associated with malignancy, particularly intraductal papilloma or carcinoma. Bilateral multiductal discharge is usually physiologic, endocrine, or related to duct ectasia.

Question 19Breast Health and Risk Assessment

For women who carry a BRCA mutation, the American Cancer Society recommends adding annual screening MRI to mammography beginning at what age?

  1. 25 to 30 Correct answer.
  2. 40
  3. 50
  4. 18

Explanation

Annual breast MRI is recommended as an adjunct to mammography for BRCA carriers starting at age 25 to 30, with some guidelines individualizing based on the youngest affected relative. MRI is more sensitive than mammography in this high-risk group.

Question 20Breast Health and Risk Assessment

Bilateral risk-reducing mastectomy in a BRCA1 carrier reduces breast cancer risk by approximately:

  1. 30%
  2. 50%
  3. 90% or more Correct answer.
  4. 75%

Explanation

Prophylactic mastectomy reduces the incidence of breast cancer in high-risk women by roughly 90 to 95 percent, though it does not eliminate risk entirely and does not address ovarian cancer risk. It is usually combined with risk-reducing salpingo-oophorectomy in BRCA carriers.

Question 21Breast Health and Risk Assessment

Chemoprevention with a selective estrogen receptor modulator is generally offered to women whose five-year Gail model risk is at least:

  1. 5%
  2. 1.67% Correct answer.
  3. 0.5%
  4. 10%

Explanation

The FDA labeling threshold for tamoxifen and raloxifene chemoprevention is a five-year Gail risk of 1.67 percent, which is the risk of an average 60-year-old woman. Benefit is largely limited to estrogen receptor-positive disease.

Question 22Breast Health and Risk Assessment

Which factor is incorporated into the Tyrer-Cuzick (IBIS) model but not the Gail model?

  1. Ashkenazi Jewish ancestry and breast density Correct answer.
  2. Age at menarche
  3. Number of prior breast biopsies
  4. Age at first live birth

Explanation

Tyrer-Cuzick adds family history detail, Ashkenazi ancestry, and mammographic density, among other variables, which makes it a more comprehensive tool for women with strong family histories. Gail uses the simpler set of reproductive and biopsy variables plus first-degree relatives.

Question 23Breast Health and Risk Assessment

What is the appropriate surgical management of a phyllodes tumor of the breast?

  1. Observation with annual MRI surveillance
  2. Mastectomy with axillary lymph node dissection
  3. Wide local excision with negative margins Correct answer.
  4. Simple enucleation of the mass

Explanation

Phyllodes tumors are treated with wide local excision achieving negative margins, because inadequate margins predispose to local recurrence. They spread hematogenously rather than through lymphatics, so axillary dissection is not indicated unless nodes are clinically involved.

Question 24Breast Health and Risk Assessment

A woman received mantle radiation for Hodgkin lymphoma at age 15. When should she begin breast cancer screening with mammography plus MRI?

  1. Age 40, with annual mammography alone
  2. At menarche, regardless of radiation dose
  3. Age 25, or 8 years after radiation Correct answer.
  4. Age 30, with MRI only until age 40

Explanation

Survivors of chest radiation before age 30 are considered high risk and should begin annual mammography with adjunct MRI at age 25 or eight years after radiation, whichever comes later. In this case, the later milestone is age 25 because she was treated at 15.

Question 25Breast Health and Risk Assessment

Which personal history meets NCCN criteria for referral for genetic risk evaluation?

  1. Ductal carcinoma in situ treated at age 65
  2. Fibroadenoma excised at age 30
  3. Stage I estrogen receptor-positive cancer at age 70
  4. Triple-negative breast cancer diagnosed at age 45 Correct answer.

Explanation

Triple-negative breast cancer diagnosed at age 60 or younger is a stand-alone indication for genetic evaluation under NCCN criteria. Older age at diagnosis with hormone receptor-positive disease is much less likely to reflect an inherited predisposition.

Question 26Breast Health and Risk Assessment

The axillary extension of breast tissue that crosses the lateral border of the pectoralis major toward the axilla is known as which structure?

  1. The Montgomery glands of the areola
  2. The ampulla of the lactiferous duct
  3. The suspensory (Cooper) ligaments
  4. The tail of Spence Correct answer.

Explanation

The tail of Spence is the portion of glandular tissue extending from the upper outer quadrant into the axilla. Because it lies outside the breast mound, it must be deliberately examined and imaged or cancers there can be missed.

Question 27Breast Health and Risk Assessment

Early menarche increases lifetime breast cancer risk. Which age at menarche is generally used to define early menarche?

  1. Age 14 years
  2. Age 16 years
  3. Age 12 years or younger Correct answer.
  4. Age 9 years or younger

Explanation

Risk rises as the number of ovulatory cycles a woman experiences increases, so menarche at 12 or earlier and menopause after 55 both raise risk modestly. The effect reflects cumulative exposure of breast epithelium to endogenous estrogen and progesterone.

Question 28Breast Health and Risk Assessment

A 26-year-old woman has a palpable, tender breast mass and no family history of breast cancer. What is the most appropriate initial imaging study?

  1. Contrast-enhanced MRI of both breasts
  2. Whole-body positron emission tomography
  3. Targeted breast ultrasound Correct answer.
  4. Bilateral screening mammography

Explanation

In women younger than 30, breast tissue is typically dense, which lowers mammographic sensitivity, and radiation exposure is a greater concern; ultrasound is therefore the first-line study for a palpable mass. Mammography is added when ultrasound findings are suspicious or when the woman is older.

Question 29Breast Health and Risk Assessment

Which description is most typical of a simple fibroadenoma on physical examination?

  1. Ill-defined thickening accompanied by peau d'orange
  2. Soft, diffuse tenderness without a discrete mass
  3. A fixed, hard, irregular mass tethered to the skin
  4. A well-circumscribed, mobile, rubbery mass Correct answer.

Explanation

Fibroadenomas are benign fibroepithelial lesions common in younger women and classically feel smooth, well-defined, and very mobile, sometimes called a breast mouse. Ultrasound usually confirms the diagnosis, with core biopsy reserved for atypical imaging or growth.

Question 30Breast Health and Risk Assessment

Having one first-degree relative with breast cancer increases a woman's risk of breast cancer by approximately how much compared with a woman with no affected relatives?

  1. About fiftyfold
  2. About tenfold
  3. No measurable increase
  4. About twofold Correct answer.

Explanation

One affected first-degree relative roughly doubles risk, and two affected first-degree relatives raise it about threefold. Risk climbs further when the relative was premenopausal or had bilateral disease.

Question 31Breast Health and Risk Assessment

A breastfeeding woman with uncomplicated lactational mastitis has been started on an appropriate antibiotic. What additional instruction should the nurse give?

  1. Discontinue nursing on the affected breast until the course is complete
  2. Apply warm compresses only after the infection resolves
  3. Continue nursing or pumping the affected breast Correct answer.
  4. Bind the breast tightly to reduce milk production

Explanation

Effective milk removal is central to resolving mastitis, so feeding or pumping should continue on both breasts. Abrupt weaning causes stasis that can progress to abscess, and comfort measures such as warm compresses before feeds aid let-down.

Question 32Breast Health and Risk Assessment

A patient's BRCA1 sequencing result reports a variant of uncertain significance. How should this result be interpreted?

  1. The result should not change her medical management Correct answer.
  2. She needs no further follow-up because the variant is benign
  3. She should be treated as a BRCA1 carrier and offered risk-reducing surgery
  4. The result confirms hereditary breast cancer and her siblings should be tested

Explanation

A variant of uncertain significance is a genetic change whose disease-causing role has not been established, so management should be based on her personal and family history instead. Such variants are frequently reclassified over time as evidence accumulates.

Question 33Breast Health and Risk Assessment

For a woman with a BRCA1 pathogenic variant, risk-reducing salpingo-oophorectomy at the recommended age lowers breast cancer risk by approximately:

  1. 5%
  2. 95%
  3. 50% Correct answer.
  4. 0%

Explanation

Removing the ovaries before natural menopause eliminates a major source of circulating estrogen and progesterone, cutting breast cancer risk by roughly half. The procedure also dramatically reduces ovarian and fallopian tube cancer risk, which is why it is offered even to women who decline mastectomy.

Question 34Breast Health and Risk Assessment

A woman at 18 weeks' gestation has a suspicious breast mass. Which statement about diagnostic core needle biopsy is correct?

  1. It is safe and needed to establish a tissue diagnosis Correct answer.
  2. It should be deferred until after delivery to protect the fetus
  3. It should be replaced by fine-needle aspiration, which is equally definitive
  4. It is contraindicated because of the risk of preterm labor

Explanation

Core needle biopsy under local anesthesia can be performed safely during pregnancy and is required because pregnancy-related breast changes often mask cancer and diagnosis is frequently delayed. Histology is essential, since aspiration cytology cannot distinguish invasive from in situ disease.

Question 35Breast Health and Risk Assessment

Which reproductive history is associated with an increased risk of breast cancer?

  1. Breastfeeding for 2 years or longer
  2. Nulliparity or first birth after age 30 Correct answer.
  3. Bilateral salpingo-oophorectomy at age 45
  4. A first live birth at age 20

Explanation

Women who never complete a pregnancy, or who delay a first birth past about age 30, have a higher risk than women whose first birth occurs early. Early parity is thought to be protective because it permanently differentiates breast epithelium, while breastfeeding and removal of the ovaries each lower risk.

Question 36Breast Health and Risk Assessment

Why does obesity raise breast cancer risk specifically in postmenopausal women?

  1. Obesity increases insulin sensitivity, which protects breast tissue
  2. Peripheral aromatization in adipose tissue raises estradiol Correct answer.
  3. Obesity reduces adipose inflammation, lowering cancer risk
  4. Obesity is linked to later menarche, reducing lifetime estrogen exposure

Explanation

After menopause the ovaries no longer produce most estrogen, and adipose tissue becomes the main site where androgens are converted to estrone and estradiol by aromatase. Higher body mass also raises insulin levels and inflammatory mediators, both of which can promote tumor growth.

Question 37Breast Health and Risk Assessment

A woman is told that her 5-year risk of developing breast cancer is 3%. How should the nurse explain this figure?

  1. Three percent of her future mammograms are likely to be abnormal
  2. A 3 in 100 chance of developing breast cancer within 5 years Correct answer.
  3. Her risk is three times that of an average woman her age
  4. She has a 3% chance of dying of breast cancer within the next 5 years

Explanation

This figure is an absolute risk: among 100 women with the same profile, about 3 would be expected to develop invasive breast cancer over 5 years. Absolute risk conveys the actual probability of disease and is distinct from relative risk and from outcomes such as mortality.

Question 38Breast Health and Risk Assessment

A woman of Ashkenazi Jewish ancestry with breast cancer is referred for genetic evaluation at any age because the population frequency of BRCA founder mutations is approximately:

  1. 1 in 40 Correct answer.
  2. 1 in 400
  3. 1 in 4
  4. 1 in 1,000,000

Explanation

About 2% to 2.5% of Ashkenazi Jewish individuals carry one of three well-recognized BRCA founder mutations, roughly ten times the frequency in the general population. This high carrier rate is why ancestry alone lowers the threshold for offering testing.

Question 39Breast Health and Risk Assessment

A young woman is found to carry a TP53 pathogenic variant (Li-Fraumeni syndrome). Which approach to breast surveillance is most appropriate?

  1. Alternating mammography and ultrasound every 6 months starting at age 20
  2. Annual MRI from the early twenties, adding mammography later Correct answer.
  3. Annual mammography alone, beginning at about age 25
  4. No breast surveillance until age 40

Explanation

TP53 carriers are unusually radiosensitive and develop cancers at young ages, so annual breast MRI is the cornerstone of surveillance beginning in the early twenties, with mammography generally added around age 30. Whole-body MRI is also used because of the broad tumor spectrum in this syndrome.

Question 40Breast Health and Risk Assessment

Which statement about male breast cancer risk in BRCA mutation carriers is accurate?

  1. BRCA1 confers the highest male breast cancer risk of any gene
  2. BRCA1 and BRCA2 confer equal risk of male breast cancer
  3. Neither BRCA gene is associated with male breast cancer
  4. BRCA2 raises male breast cancer risk far more than BRCA1 Correct answer.

Explanation

BRCA2 is the gene most strongly associated with male breast cancer, with a lifetime risk in carriers of roughly 6% to 8%, whereas BRCA1 raises male risk only slightly. A man with breast cancer therefore has a substantial chance of carrying a BRCA2 mutation and should be offered genetic evaluation.

Question 41Screening, Diagnosis, and Staging

On a screening mammogram report, a BI-RADS category 0 assignment indicates which of the following?

  1. A probably benign finding for which short-interval follow-up is advised
  2. A highly suspicious finding requiring biopsy without further imaging
  3. Additional imaging or comparison with prior studies is needed Correct answer.
  4. The breasts are entirely fatty with no suspicious finding

Explanation

BI-RADS 0 means the study is incomplete and a final assessment cannot be made until extra views, ultrasound, or prior films are reviewed. It is a call-back category, not a diagnosis.

Question 42Screening, Diagnosis, and Staging

Which finding corresponds to stage 0 breast cancer?

  1. Invasive carcinoma with ipsilateral supraclavicular lymph node involvement
  2. Ductal carcinoma in situ confined by the basement membrane Correct answer.
  3. A 3-cm invasive tumor with one positive mobile axillary node
  4. Invasive ductal carcinoma measuring 1.2 cm with negative lymph nodes

Explanation

Stage 0 denotes in situ disease, in which malignant cells have not breached the basement membrane and therefore cannot metastasize. Both ductal and lobular carcinoma in situ fall into this category.

Question 43Screening, Diagnosis, and Staging

A 47-year-old woman presents with a new, firm, palpable breast mass. Which is the most appropriate initial imaging evaluation?

  1. Whole-body PET-CT with contrast
  2. Diagnostic mammography plus targeted ultrasound Correct answer.
  3. Bilateral screening mammography performed alone
  4. Breast MRI as the initial imaging study

Explanation

A palpable mass requires a diagnostic study, meaning imaging tailored to and interpreted in light of the symptom; mammography plus ultrasound of the area is standard. Tissue sampling follows any suspicious finding.

Question 44Screening, Diagnosis, and Staging

A breast lesion assigned BI-RADS category 5 carries what approximate likelihood of malignancy?

  1. 95% or greater Correct answer.
  2. Approximately 50%
  3. Approximately 10%
  4. Less than 2%

Explanation

BI-RADS 5 designates a finding that is highly suggestive of malignancy, with a positive predictive value of at least 95%. Biopsy is indicated without further imaging workup.

Question 45Screening, Diagnosis, and Staging

The sentinel lymph node is best described as which node?

  1. The internal mammary node nearest the tumor
  2. The largest palpable axillary lymph node
  3. The most superior node in axillary level III
  4. The first node(s) draining the tumor bed Correct answer.

Explanation

The sentinel node is the first node in the lymphatic pathway draining the primary tumor and is identified with blue dye, radiolabeled colloid, or both. If it is free of tumor, the remaining basin is usually spared dissection.

Question 46Screening, Diagnosis, and Staging

A breast tumor measures 1.8 cm and shows no skin or chest wall involvement. Which T category applies?

  1. T2
  2. T1 Correct answer.
  3. T3
  4. T4

Explanation

In the TNM system, T1 tumors measure 2 cm or less in greatest dimension. Size thresholds are T1 up to 2 cm, T2 over 2 to 5 cm, T3 over 5 cm, and T4 for direct extension to skin or chest wall.

Question 47Screening, Diagnosis, and Staging

Which finding defines stage IV breast cancer?

  1. Distant metastasis, such as to bone or lung Correct answer.
  2. Metastasis in ipsilateral supraclavicular lymph nodes
  3. Tumor larger than 5 cm without nodal involvement
  4. Metastasis in ipsilateral level I axillary nodes

Explanation

Stage IV is defined by distant metastatic spread to organs or nonregional nodes, regardless of the size of the primary tumor or regional nodal status.

Question 48Screening, Diagnosis, and Staging

Which method is the standard for determining estrogen receptor status in breast carcinoma?

  1. Immunohistochemistry performed on the tumor tissue Correct answer.
  2. Fluorescence in situ hybridization for ESR1 amplification
  3. Flow cytometry of peripheral blood mononuclear cells
  4. Serum enzyme immunoassay for circulating estradiol

Explanation

Estrogen and progesterone receptor status is determined by immunohistochemistry on formalin-fixed tumor tissue, with the percentage and intensity of stained nuclei reported. Receptor status is a tissue biomarker and cannot be inferred from blood hormone levels.

Question 49Screening, Diagnosis, and Staging

Why is core needle biopsy generally preferred over fine-needle aspiration for a suspicious solid breast mass?

  1. It eliminates the need for image guidance during sampling
  2. It preserves tissue architecture and permits receptor testing Correct answer.
  3. A single needle pass is sufficient to classify the lesion
  4. It has a lower false-negative rate only when the mass is cystic

Explanation

Core biopsy yields tissue cores that show architecture, allowing the pathologist to distinguish in situ from invasive carcinoma, assign histologic grade, and perform ER, PR, and HER2 testing. Cytology from aspiration provides cells only.

Question 50Screening, Diagnosis, and Staging

A 52-year-old has a rapidly enlarging, erythematous, edematous right breast with peau d'orange over more than one-third of the skin surface and no discrete mass. Which statement is correct?

  1. Inflammatory breast cancer is defined by a dominant mass larger than 5 cm
  2. The condition is staged as stage II regardless of nodal status
  3. Imaging alone establishes the diagnosis, so a tissue biopsy is unnecessary
  4. Diagnosis is clinical, supported by a skin punch biopsy Correct answer.

Explanation

Inflammatory breast cancer is a clinical diagnosis requiring erythema and edema involving at least one-third of the breast with rapid onset; a skin punch biopsy showing dermal lymphatic tumor emboli supports it. It is classified T4d and is at least stage IIIB.