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Self-Assessment Questions

Oncology

Breast Cancer: Review Questions

A. Ruggeri, MD, and Lajos Pusztai, MD, PhD

Dr. Ruggeri is a Clinical Specialist in Medical Oncology, and Dr. Pusztai is an Assistant Professor of Medicine, Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.


Choose the single best answer for each question.

1. A 45-year-old woman sees her primary care physician (PCP) because of a 1-cm palpable mass in her left breast. Mammography confirms the presence of a suspicious density in the upper outer quadrant, and core needle biopsy shows ductal carcinoma in situ. Which of the following management approaches is optimal for this patient?
  1. Perform lumpectomy only
  2. Perform lumpectomy and administer tamoxifen for 5 years
  3. Perform lumpectomy, followed by radiation therapy, and consider administration of tamoxifen for 5 years
  4. Perform lumpectomy, followed by radiation therapy and chemotherapy, and consider administration of tamoxifen for 5 years
  5. Perform mammography every 6 months
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2. A 52-year-old woman notices a mass in her left breast during a breast self-examination. Mammography shows a spiculated lesion corresponding to the palpable mass, and diagnostic core needle biopsy reveals infiltrating ductal carcinoma (IDC). Results of staging work-up, including bone scan, chest radiography, and computed tomography of the abdomen are negative for metastatic disease. She undergoes lumpectomy with axillary lymph node dissection. Pathology results show a 3.5-cm, poorly differentiated, estrogen- and progesterone-receptor–positive IDC. Resection margins are clear; all 12 lymph nodes are negative for metastatic cancer. Which of the following should be included in further treatment of this patient?

  1. Close follow-up with mammography, chest radiography, complete blood count, and tumor marker analysis every 6 months
  2. Administration of tamoxifen alone
  3. Administration of tamoxifen and radiation therapy
  4. Administration of tamoxifen and anthracycline-based chemotherapy
  5. Administration of tamoxifen, anthracycline-based chemotherapy, and radiation therapy
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3. A 58-year-old woman with a history of invasive breast cancer is currently taking tamoxifen 20 mg daily as adjuvant hormonal therapy. Which of the following is a potential adverse effect of her treatment?
  1. Acute leukemia
  2. Congestive heart failure
  3. Coronary artery disease
  4. Deep venous thrombosis
  5. Hand and foot erythema and pain
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4. A 66-year-old woman with breast cancer that has metastasized to the bone visits her PCP. Her oncologist has recommended hormonal therapy with an aromatase inhibitor (eg, letrozole, anastrozole, exemestane) and intravenous infusions of pamidronate 90 mg every 3 weeks. Which of the following benefits can she expect from her bisphosphonate therapy?

  1. Potentiation of the anticancer activity of letrozole
  2. Prolongation of her life
  3. Reduced risk for bony complications from her cancer
  4. Shrinkage of her cancer
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5. A 28-year-old woman with breast cancer has a strong history of sarcoma and leukemia cancers in relatives on the maternal side of her family. Which of the following is most likely the genetic abnormality carried in her family?

  1. BRCA1
  2. BRCA2
  3. Cowden MMAC/PTEN
  4. HNPCC
  5. TP53
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