Question 1 : What percentage of breast caners are associated with known germline mutations :
a) 5
b) 10
c) 15
d) 20
Answer : 10%
Question 2 : Which of the following is a feature of BRCA1-related breast cancers distinguishing them from both BRCA2-related cancers:
a) BRCA1 related tumors are of high histologic grade, high proliferative rate and absence of estrogen receptor (ER), progesterone receptor (PR) , and human epidermal growth factor receptor 2 (HER2)
b) BRCA2-related cancers are characterized by a basal-like gene expression profile of cytokeratins 5/6, 14, and 17, epidermal growth factor, and P-cadherin
c) BRCA-1 related tumors are of low histologic grade, low proliferative rate and absence of estrogen receptor (ER), progesterone receptor (PR), and presence of human epidermal growth factor receptor 2 (HER2)
d) None of the above is true
Answer : BRCA1 related tumors are of high histologic grade, high proliferative rate and absence of estrogen receptor (ER), progesterone receptor (PR) , and human epidermal growth factor receptor 2 (HER2)
Question 3 : Olaparib was approved by the FDA in:
a) Germline BRCA-positive , HER2-negative metastatic breast cancer in patients who have previously received chemotherapy in the neoadjuvant, adjuvant, or metastatic settings
b) Germline BRCA-negative , HER2-negative metastatic breast cancer in patients who have previously received chemotherapy in the neoadjuvant, adjuvant, or metastatic settings
c) Germline or somatic BRCA-Positive , HER2-negative metastatic breast cancer in patients who have previously received chemotherapy in the neoadjuvant, adjuvant, or metastatic settings
d) Germline BRCA-Positive , HER2-negative metastatic breast cancer in patients who have never previously received chemotherapy in the neoadjuvant, adjuvant, or metastatic settings
Answer : Germline BRCA-Positive , HER2-negative metastatic breast cancer in patients who previously received chemotherapy in the neoadjuvant, adjuvant, or metastatic settings
Question 4 : The HER2 oncogene is located on :
a) Chromosome 16q12
b) Chromosome 17q12
c) Chromosome 12q17
d) Chromosome 12q16
Answer : Chromosome 17q12
Question 5 : Which of the following is true about breast cancer subtypes :
a) Luminal A tumors are more common than other subtypes and are characterized by high expression levels of ER-related genes and low expression of the HER2 cluster and proliferation -associated genes
b) Luminal B tumors are characterized by lower expression levels of ER-related genes , variable expression of the HER2 cluster, and higher levels of proliferation-associated genes
c) HER2-enriched subtype overexpresses both HER2 and proliferation associated genes and has lower expression of ER-related genes
d) All of the above
Answer : all of the above
Question 6 : Which of the following has the lower frequency of mutated genes compared to others :
a) Luminal A type breast cancer
b) Luminal B type breast cancer
c) HER2-enriched breast cancer
d) All have similar frequency
Answer : HER2-enriched breast cancer
Question 7 : Which of the following is not true about the MammaPrint assay used in breast cancer :
a) It’s a 70-gene assay
b) the MINDACT trial studied patients, only lymph node negative ones, to assess whether or not this assay may identify patients who may be spared chemotherapy
c) The majority of the patients included in the MINDACT trial were ER-positive , PR-positive and HER2-negative
d) All of the above
Answer : The MINDACT trial studied patients, only lymph node negative ones, to assess whether or not this assay may identify patients who may be spared chemotherapy
Question 8 : Which of the following is a 50-gene signature based test in breast cancer :
a) Oncotype DX
b) MammaPrint
c) Prosigna
d) Coloprint
Answer : Prosigna
Question 9 : Which of the following is not true about BRCA gene mutations and cancer :
a) These autosomal dominant mutations account for 5% to 10% of all breast cancers
b) The lifetime risk of breast cancer development in mutation carriers ranges from 26% to 85%
c) The risk of ovarian cancer in BRCA2 mutation carriers is 16% to 63% and in BRCA1 mutation carriers is 10% to 27%
d) Cumulative risk of breast cancer development is comparatively higher in BRCA1 mutation carriers than BRCA2 mutation carriers
Answer : The risk of ovarian cancer in BRCA2 mutation carriers is 16% to 63% and in BRCA1 mutation carriers is 10% to 27%
Question 10 : Which of the following is not an indication of genetic testing for predisposition to breast cancer :
a) Personal diagnosis of DCIs before the age of 50 years
b) Personal diagnosis of invasive breast cancer before the age of 50 years
c) Triple-positive breast cancer diagnosed 60 y and younger
d) Some cases with personal history of ovarian cancer
Answer : Triple-positive breast cancer diagnosed 60 y and younger
Question 11 : Which of the following syndrome has a higher propensity for HER2-positive breast cancers :
a) BRCA2 mutation associated HBOC
b) Diffuse gastric cancer syndrome
c) Li-Fraumeni syndrome
d) Peutz-Jeghers syndrome
Answer : Li-Fraumeni syndrome
Question 12 : Which of the following was the finding of Women’s Health Initiative study :
a) Hormone replacement therapy containing only estrogen was associated with an increased risk of breast cancer whereas combined estrogen and progestin HRT was not
b) Hormone replacement therapy containing only progestin was associated with an increased risk of breast cancer whereas combined estrogen and progestin HRT was not
c) Hormone replacement therapy containing only estrogen was associated with an increased risk of breast cancer whereas combined estrogen and progestin HRT was having a protective effect
d) Hormone replacement therapy containing only estrogen and progestin HRT was associated with an increased risk of breast cancer
Answer : Hormone replacement therapy containing only estrogen and progestin HRT was associated with an increased risk of breast cancer
Question 13 : Which of the following woman are considered to be as high-risk for development of breast cancer :
a) Women who carry mutations in either BRCA1 or BRCA2 and those having mutations in PALB2 or CHEK2
b) Women who have a family history of genetically transmitted breast cancer
c) Those who have received mantle irradiation
d) Women having LCIS or atypical hyperplasia
e) All of the above
Answer : All of the above
Question 14 : The Gail model used for calculation of a woman’s risk of developing breast cancer is based on all of the following except :
a) Age at menarche
b) Age at first live birth
c) Numerous of previous breast biopsies
d) The number of first- and second-degree female relatives with breast cancer
Answer : The number of first- and second-degree female relatives with breast cancer
Question 15 : Which of the following is not an indication of annual MRI screening of breast cancer :
a) BRCA mutation
b) Lifetime risk of 15-20% or greater as defined by family history based models
c) Untested first-degree relative of BRCA carrier
d) None of the above
Answer : Lifetime risk of 15-20% or greater as defined by family history based models
Question 16 : All of the following are options for breast cancer risk reduction in women at high-risk except:
a) Tamoxifen in premenopausal women aged 20 years and older
b) Tamoxifen is postmenopausal women
c) Exemestene in postmenopausal women
d) Raloxifene in postmenopausal women
Answer : Tamoxifen in premenopausal women aged 20 years and older
Question 17 : What is the approximate lifetime risk of developing invasive breast cancer is a case of LCIS :
a) 1-10%
b) 30-40%
c) 0-1%
d) 10-20%
Answer : 30-40%
Question 18 : Which is the most common initial chosen strategy for the management of lobular neoplasia of the breast :
a) Chemoprevention
b) Surveillance
c) Prophylactic bilateral mastectomy
d) Ovarian ablation, either medical or surgical
Answer : Surveillance
Question 19 : DCIS is defined as the proliferation of malignant-appearing mammary ductal epithelial cells without evidence of invasion beyond the basement membrane. Which are the assays available for predicting the risk of recurrence after conservative treatment of DCIS:
a) Oncotype DX DCIS Score
b) DCISionRT
c) Both of the above
d) None of the above
Answer : both of the above
Question 20 : What percentage of breast tumor tissue should demonstrate a particular histology to be designated as that histologic type :
a) >90%
b) >70
c) >20%
d) >30%
Answer : >90%
Question 21 : The Nottingham grading system of breast cancer by Elston and Ellis includes all of the following except :
a) Tubule formation
b) Nuclear pleomorphism
c) Mitotic activity per field area
d) Mitotic activity per 10 hpf area
Answer : Mitotic activity per 10 hpf area
Question 22 : What percentage of patients with breast cancer have HER2/neu gene amplification :
a) 10%
b) 20%
c) 30%
d) <10%
Answer : 20%
Question 23 : In which of the following scenarios HER2 directed therapy is not indicated in a case of breast cancer :
a) HER2/CEP17 ratio <2 and average HER2 copy number 6 or more signals per cell
b) HER2/CEP17 ratio 2 and average HER2 copy number 2 or more signals per cell
c) HER2/CEP17 ratio 3 and average HER2 copy number 2 or more signals per cell
d) None of the above
Answer : none of the above
Question 24 : Which of the following is not an indication for surgical biopsy after core needle biopsy in case of suspected breast cancer :
a) Failure to sample calcifications
b) Diagnosis of atypical lobular hyperplasia
c) Diagnosis of pleomorphic LCIS
d) Radial scar
Answer : Diagnosis of atypical lobular hyperplasia
Question 25 : In what of the following stages of breast cancer extensive evaluations to look for metastatic disease are warranted :
a) Stage I
b) Stage II
c) Stage III
d) Evaluations to look for metastatic disease are required in all stages of breast cancer as it’s a systemic disease from very early stages
Answer : Stage III
Question 26 : The most appropriate modality for estimating the extent of DCIS preoperatively is:
a) Mammography
b) Ultrasonography of breast
c) MRI of breast
d) A combination of MRI of breast and mammography
Answer : mammography
Question 27 : Which is the preferred management option for a case of DCIS :
a) Excision followed by RT
b) Total Mastectomy
c) Excision followed by systemic chemo followed by RT
d) Excision followed by hormonal therapy
Answer : Excision followed by RT
Question 28 : Which of the following statements about DCIS is not true:
a) 80% of DCIS is lesions express ER, which is less frequent in non comedo than comedo DCIS
b) Tamoxifen given in the adjuvant setting in DCIS leads to a more significant reduction in contralateral breast cancer than in ipsilateral breast cancer recurrence
c) Anastrozole was found to be more effective than tamoxifen in post menopausal breast cancer patients of DCIS in the adjuvant setting
d) Molecular panels are commercially available for estimation of risk of DCIS leading to invasive carcinoma
Answer : 80% of DCIS is lesions express ER, which is less frequent in non comedo than comedo DCIS
Question 29 : The recurrence of breast cancer, after a breast conserving surgery (BCS) and postoperative RT, is classified as a true recurrence when:
a) It occurs within the boosted region
b) It occurs adjacent to the boosted region
c) It occurs at a distance from the original tumor
d) Its of the same histologic type regardless of the location
Answer : occurs within the boosted region
Question 30 : Which of the following is not a significant risk factor of locoregional recurrence after breast conserving therapy :
a) Younger age (less than 40 years)
b) BRCA1 or 2 mutation
c) A close deep margin post resection
d) High risk Oncotype DX score
Answer : A close deep margin post resection
Question 31 : Which of the following is not an absolute contraindication to breast conserving therapy :
a) Diffuse microcalcifications
b) Inability to obtain a cosmetically satisfactory result
c) Inflammatory breast cancer
d) History of prior radiation to the breast or chest wall
Answer : History of prior radiation to the breast or chest wall
Question 32 : RT reduces local recurrence in a case of breast cancer, after breast conserving surgery by about what percentage :
a) 30
b) 40
c) 50
d) 70
Answer : 70%
Question 33 : According to the American Society for Radiation Oncology (ASTRO) all of the following patient characteristics are suitable for accelerated partial breast irradiation (APBI) except :
a) Age 50 years or younger
b) Absence of BRCA 1/2 mutation
c) Unicentric invasive ductal carcinoma measuring ≤ 2 cm
d) Margins negative by at least 2 mm
Answer : Age 50 years or younger
Question 34 : For a woman without cardiac risk factors who was irradiated at age 50 years, the absolute risk of radiation-related acute coronary events by age 80 years is:
a) 0.9% after 0.5 Gy heart dose
b) 0.9% after 1 Gy heart dose
c) 0.9% after 2 Gy heart dose
d) 0.9% after 3 Gy heart dose
Answer : 0.9% after 3 Gy heart dose
Question 35 : Which of the following arms of the NSABP B-04 study showed a survival benefit :
a) Radial mastectomy
b) Total mastectomy with RT to the regional lymphatics
c) Total mastectomy with observation of the axillary nodes and delayed axillary lymph node dissection
d) None of the above
Answer : none of the above
Question 36 : Which is the procedure of choice for staging a patient of breast cancer who is clinically negative for axillary lymphadenopathy :
a) Sentinel node biopsy
b) Axillary lymph node dissection
c) Ultrasonography of axilla fine needle aspiration of suspicious nodes
d) MRI with contrast of whole breast of axilla
Answer : Sentinel node biopsy
Question 37 : In a patient of breast cancer axillary lymph node dissection can be avoided if three or more sentinel lymph nodes can be identified and are negative :
a) True
b) False
Answer : True
Question 38 : Post mastectomy RT is recommended in all of the following scenarios except :
a) Four or more involved lymph nodes
b) Tumors > 5 cm in women who are node positive
c) Women having high risk (>10-15%) of locoregional recurrence following RT
d) None of the above
Answer : Women having high risk (>10-15%) of locoregional recurrence following RT
Question 39 : Which of the following is not true about endocrine therapy in breast cancer :
a) Tamoxifen is associated with risks of thromboembolism and uterine cancer
b) In postmenopausal women, AI are associated with better outcomes compared with tamoxifen
c) In the ATLAS trial 10 years of adjuvant tamoxifen resulted in better DFS and OS compared with 5 years of adjuvant tamoxifen
d) Later recurrences, after 5 years, are less frequent than early recurrences in ER positive breast cancers
Answer : Later recurrences, after 5 years, are less frequent than early recurrences in ER positive breast cancers
Question 40 : In the SOFT and TEXT studies all of the following subgroup of breast cancer patients experienced reduced recurrence rates with ovarian suppression, except :
a) Patients younger than 35 years
b) Higher stages of breast cancer requiring chemotherapy
c) Patients who became menopausal with chemotherapy
d) Patients having positive axillary nodes
Answer : Patients who became menopausal with chemotherapy
Question 41 : Which of the following drugs are recommended in women with breast cancer taking aromatase inhibitors :
a) Bisphosphonates
b) Denosumab
c) Both of the above
d) Neither 1 nor 2
Answer : both of the above
Question 42 : Which of the following is not true about chemotherapy in breast cancer :
a) 2 weekly instead of 3 weekly AC followed by paclitaxel resulted in superior survival outcomes
b) 3 weekly AC followed by weekly paclitaxel resulted in better survival outcomes and better tolerability compared with 3 weekly paclitaxel
c) Sequential anthracycline- and taxane-based treatment remains the “gold standard” for breast cancer patients
d) The CMF regimen is equally efficacious to AC, whereas the combination docetaxel plus cyclophosphamide is superior to AC in women with node-negative disease or one to three positive lymph nodes
Answer : 3 weekly AC followed by weekly paclitaxel resulted in better survival outcomes and better tolerability compared with 3 weekly paclitaxel
Question 43 : Which of the following statements is incorrect about chemotherapy in non-metastatic breast cancer :
a) Triple-negative tumors with nodal involvement and/or size greater than 0.5 cm require chemotherapy
b) Hormone receptor positive tumors who are also HER2 negative and demonstrate a low risk score on Oncotype DX can avoid chemotherapy
c) Patients who are HER2 negative and ER positive derive more benefit from anthracyclines than other subtypes
d) The use of taxanes is more critical in tumors which are ER negative and HER2 positive
Answer : Patients who are HER2 negative and ER positive derive more benefit from anthracyclines than other subtypes
Question 44 : All of the following are true about HER2-overexpressing breast cancer except :
a) They are relatively resistant to endocrine therapy
b) NSABP B-31/NCCTC N9831, HERA, FinHER are trials of trastuzumab in breast cancer in the palliative setting
c) Risk factors for trastuzumab induced cardiomyopathy are concurrent anthracycline use, preexisting cardiac disease and age older than 65 years
d) The optimal duration of adjuvant trastuzumab is 1 year
Answer : NSABP B-31/NCCTC N9831, HERA, FinHER are trials of trastuzumab in breast cancer in the palliative setting
Question 45 : Which of the following tests routinely done in breast caner survivors :
a) Clinical examination and annual mammography
b) Clinical examination and annual mammography and serum alkaline phosphate
c) Clinical examination and annual mammography and serum alkaline phosphate and ultrasonography of abdomen
d) Clinical examination and annual mammography and serum alkaline phosphate and ultrasonography of abdomen with 3 yearly chest CT scan and bone scan
Answer : Clinical examination and annual mammography
Question 46 : Which of the most appropriate treatment of Paget disease of breast :
a) Mastectomy
b) Breast conserving therapy
c) Local excision without RT
d) None of the above
Answer : Mastectomy
Question 47 : Which of the following is not true about male breast cancer :
a) The strongest association of male breast cancer is with Klinefelter syndrome
b) Hypoandrogenism and gynecomastia are risk factors
c) Male breast tumors are more likely to have hormone receptor positive status
d) Total mastectomy is the most commonly employed treatment
Answer : Hypoandrogenism and gynecomastia are risk factors
Question 48 : Which of the following statements is not true about phyllodes tumor :
a) They can be benign or malignant depending on various histologic features, the most important of which is stromal invasion
b) Local excision is the treatment of choice for both benign and malignant lesions
c) Axillary lymph nodes are the most common site of metastasis thus axillary dissection is routinely undertaken in malignant phyllodes tumor but may be avoided in benign tumors
d) Systemic therapy in metastatic cases in one of the lines of sarcoma
Answer : Axillary lymph nodes are the most common site of metastasis thus axillary dissection is routinely undertaken in malignant phyllodes tumor but may be avoided in benign tumors
Question 49 : Which of the following statements is not true about inflammatory breast cancer :
a) It is clinical diagnosis and dermal lymphatic invasion is not necessary for the diagnosis
b) IBC are less likely to have hormone receptor positivity and more likely to be triple negative , or HER2 overexpressing
c) In patients who attain a pathological complete response (pCR) with neoadjuvant chemotherapy, breast conserving therapy may be pursued
d) Surgery is contraindicated in IBC unless there is complete resolution of the inflammatory skin changes
Answer : In patients who attain a pathological complete response (pCR) with neoadjuvant chemotherapy, breast conserving therapy may be pursued
Question 50 : If a patient of metastatic breast cancer with bone mets and limited lung mets is started on tamoxifen and develops progression of lung mets and increases in bone pains, the most appropriate next line of management will be:
a) Wait and watch
b) Shift to aromatase inhibitors
c) Shift to fulvestrant
d) Shift to systemic chemotherapy
Answer : wait and watch