Chapter 1

Question 1

“The biggest risk factor for developing breast cancer is
(A)a family history of breast cancer
(B)a personal history of breast cancer
(C)gender
(D)not breastfeeding”

Answer 1

“C) Certain factors increase a woman’s risk of developing breast cancer. These are divided into major and minor risk factors. Major risk factors are those that are not in a woman’s control, such as gender and age. Minor risk factors are linked to cancer-causing factors in the environment or may be related to personal choices, such as using hormone replacement therapy (HRT). Simply being a woman is the main risk factor for developing breast cancer. Breast cancer can also affect men, but this disease is much more common among women than men.”

Question 2

“One of the minor risk factors for developing breast cancer could be
(A)gender
(B)aging
(C)genetic risk factors
(D)not breastfeeding”

Answer 2

“(D) A risk factor is anything that increases a person’s chances of developing a disease. Major risk factors cannot be changed. Minor risk factors are linked to cancer-causing factors in the environment or may be related to personal choices, such as breastfeeding.”

Question 3

“What is the approximate risk of developing breast cancer in a woman whose sister has the disease?
(A)Higher-than-normal risk
(B)No significant change in risk
(C)Lower than normal risk
(D)None of the above”

Answer 3

“(A) Higher-than-normal or major risk factors carry a significantly higher risk of developing breast cancer compared with minor risk factors. Breast cancer risk is higher among women whose close blood relatives suffer from the disease. Blood relatives can be either from the mother’s side or the father’s side of the family.”

Question 4

“A woman with the highest risk of developing breast cancer is
(A)aged 30 years or younger
(B)older than 50 years
(C)between the ages of 30 and 40 years
(D)older than 20 years but younger than 30 years”

Answer 4

“(B) A woman’s risk of developing breast cancer increases with advancing age. Older women are at the highest risk. At the age of 30 years, a woman has a 0.5% (or 1 in 209) risk of developing breast cancer. At the age of 40 years, a woman has a 1.5% or 1 in 65 risk of developing breast cancer. At age 50 years a woman has a 2.4% (or 1 in 42) risk of developing breast cancer. At the age of 60 years, a woman has a 3.5% (or 1 in 28) risk of developing breast cancer. At the age of 70 years, a woman has a 4.1% (or 1 in 25) risk of developing breast cancer. At the age of 80 years, a woman has a 3.0% (or 1 in 33) risk of developing breast cancer. The lifetime risk of developing breast cancer is 12.8% (or 1 in 8).”

Question 5

“Symptoms of a possible breast disease that are not be demonstrated on a mammogram may include
(A)nipple discharge
“(B)skin thickening
(C)circumscribed tumors
(D)stellate lesions”

Answer 5

“(A) Skin thickening or tumors and lesions are seen on a mammogram, whereas nipple discharge is not seen on a mammogram. Although a nipple discharge can indicate malignancy, most nipple discharges or secretions are not indicative of cancer. In general, if the secretion appears clear, milky, yellow, or green, cancer is very unlikely. Further testing with high-frequency ultrasound techniques or other tests, such as a ductography or galactography, help determine the cause of nipple discharge.”

Question 6

“Which of the following best describes a type of drug treatment given in addition to another breast cancer treatment?
(A)Radiation therapy
(B)Chemotherapy
(C)Adjuvant chemotherapy
(D)Hormone therapy”

Answer 6

“(C) Chemotherapy can be administered before or after cancer surgery with or without other treatments. Neoadjuvant chemotherapy is administered before surgery to help shrink the cancerous tumor. Adjuvant chemotherapy is chemotherapy administered in addition to another breast cancer treatment, for example, mastectomy.”

Question 7

“Human epidermal growth factor receptor 2 (HER2) or erb-b2 receptor tyrosine kinase 2 (ERBB2) receptor is
(A)a protein, which functions as a receptor on breast cells
(B)a virus, which functions to minimize the recurrence of breast cancer
(C)a protein, which functions to reduce breast cancer risks
(D)a virus, which functions as a receptor on breast cells”

Answer 7

“(A) HER2 or ERBB2 is a protein, which functions as a receptor on breast cells. The protein receptors control how the breast cells divide and repair themselves. HER2 can be overstimulated in some women, resulting in a more aggressive form of breast cancer. Women with triple-negative breast cancer have little of the ERBB2 protein.”

Question 8

“Risks factors associated with undergoing hormone replacement therapy (HRT) include
(A)early menopause
(B)late menopause
(C)increased risks of birth defects
(D)increased risks of developing breast cancer”

Answer 8

“(D) Minor factors are linked to cancer-causing factors in the environment or may be related to personal choices, such as using HRT. Simply being a woman is the main risk factor for developing breast cancer. Breast cancer can also affect men, but this disease is much more common among women than men.”

Question 9

“The American Cancer Society (ACS) recommends that
(A)women younger than 45 years with a high risk can can have modality screening in addition to mammography
(B)women younger than 40 years should have screening mammography every year
(C)painful masses or lumps in the breast are most likely benign and can be ignored
(D)women between the ages of 20 and 39 years should undergo a CBE every year”

Answer 9

“(A) The guidelines suggested by ACS are as follows:
*For women aged 30 years
*Assessment and screening if needed
*For women aged 40 to 44 years with average risk factor
*Annual breast cancer screening is an option
*For women aged 45 to 54 years
*Mammography recommended every year
*For women aged 55 years and older
*Mammography every 1 or 2 years
*Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer
*MRI or ultrasound screening only for women with high-risk factors or very dense breast (Fig. 1–1)
*ACS does not recommend breast examination for breast cancer screening among average-risk women at any age”

Question 10

“Which of the following breast changes should a health care provider evaluate?
1.Lumps or swellings
2.Skin irritation or dimpling
3.Milky discharge from the nipple
(A)1 only
(B)1 and 2 only
(C)2 and 3 only
(D)1, 2, and 3”

Answer 10

“(B) Changes, such as a lump or swelling, tenderness, skin irritation or dimpling, and nipple pain or retraction, should be evaluated as soon as possible. In general, if the nipple discharge is clear, milky, yellow, or green, cancer is unlikely. If the discharge is red or red brown, suggesting blood, it could be caused by a malignant or benign condition and should be evaluated.”

Question 11

“Which of the following should the technologist document?
(A)Edema
(B)Dimpling of the skin
(C)A and B
(D)A only”

Answer 11

“C) The conditions mentioned in options (A) and (B) must be documented. Other signs and symptoms that should be documented are lumps, skin thickening, nipple discharge, skin changes, nipple and areola changes, and erythema.”

Question 12

“Preexamination instructions that can be given to the patient include
(A)remove all clothing from the waist down
(B)use a wet-wipe to remove all deodorant
(C)remove panties
(D)drink a full glass of water before the mammogram”

Answer 12

“(B) The patient should remove all clothing from the waist up, which is the area of interest. Underarm deodorant should be wiped off to prevent any possibility of misdiagnosis. The remnant of the deodorant can appear as microcalcifications on the mammograms. Drinking water will not affect the mammogram.”

Question 13

“Benefits of communication with the patient include
(A)helps identify sensitive breast and the reason for the sensitivity
(B)educates the patient
(C)reveals fears and misconceptions
(D)all of the above”

Answer 13

“(D) Communication is important during the mammography because a relaxed patient is easier to position. The technologist should strive to develop a rapport with the patient before starting the examination. The patient will not only be more relaxed but also perceive the technologist as competent if her needs—both physical and emotional—are adequately met during the examination. For example, a patient who is nervous about the radiation dose can be reassured by informing her about the actual dose during mammography and the Mammography Quality Standards Act (MQSA) regulations in place to ensure that the dose is not exceeded.”

Question 14

“In developing patient rapport, the technologist should strive to enhance the patient’s self-esteem. This means that the technologist should
(A)reflect the patient’s emotions to show understanding
(B)agree unconditionally with anything the patient says
(C)say “I understand” to any comment the patient makes
(D)offer reassurance and encouragement if the patient is confused or unable to help herself

Answer 14

“(D) The technologist should preserve the patient’s self-esteem by helping the patient feel good about herself. For enhancing the patient’s self-esteem, the technologist should offer reassurance and encouragement if the patient is embarrassed, confused, or unable to help herself. The technologist should be specific and sincere and treat the patient as someone important. However, the technologist should not show pity or repeat the patient’s remarks word for word.”

Question 15

“The two-step method of breast self-examination (BSE) is to
(A)look and feel for changes in the breast
(B)examine the breasts and underarm
(C)check for lumps in the breast and keep a journal of changes in the breast
(D)examine the breasts and nipples”

Answer 15

“(A) For BSE, the first step is to look for changes in the breast when the patient is in either the standing position or the sitting position. A check should be made for indentations, retracted nipples, dimpling, or prolonged skin conditions such as eczema. Other visual changes can include the development of unequal-sized breasts; changes in texture, color, or contour; and redness or scaliness. Moles and scars should also be noted and recorded. The next step is feeling for changes. While feeling for changes, the breast should be examined in both the upright and supine positions by using the pads of three or more fingers to apply varying degrees of pressure—firm pressure to assess deep lesions, medium pressure for intermediate-depth lesions, and light pressure to assess lesions just below the skin surface. The entire breast must be checked. In any examination, lotion or powder can be used to help the fingers glide across the breast. Some women also prefer to examine their breasts in the shower, where wet fingers will glide easily over the breast (Fig. 1–2).”

Question 16

“When visually inspecting the breast, the changes that should be recorded include
1.changes in breast size and shape
2.changes in texture or color of the breast
3.indentations on the skin of the breast
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 16

“(D) The visual stage of a BSE involves checking for signs of breast cancer. These signs can include changes in the size, texture, or color of the breast; prolonged skin irritation; redness or scaliness; dimpling; or nipple retraction.”

Question 17

“The patient’s medical history and documentation will
1.provide the radiologist information about the patient’s risk factors for developing breast cancer
2.give the radiologist information about general symptoms of breast cancer
3.provide information about possible benign breast conditions of the patient
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 17

“(C) The first step in evaluating a woman with suspected breast cancer is obtaining the complete medical history and performing a physical or clinical examination. The medical history provides information about the patient’s symptoms and any other health problems and risk factors for developing benign or malignant breast conditions. The radio­logist will not need general information on symptoms of breast cancer. A clinical examination can locate any lump or suspicious areas and reveal the texture, size, and shape of the breast. Any changes in the nipples or skin of the breast are also noted. Once the medical and clinical examinations are completed, biopsy or imaging tests, such as mammography, can be performed.”

Question 18

“Stressing the importance of the BSE can be controversial because
(A)BSE tends to detect only benign breast cancer
(B)BSE will help in the detection of malignant breast conditions
(C)mammography is not 100% effective
(D)BSE can cause unnecessary anxiety in women

Answer 18

“(D) Some studies have called for an end to routine BSE for women aged 40 to 69 years. The theory is that BSE and BSE education do not reduce death rates but increase the chances of unnecessary biopsies and cause anxiety. Although ACS no longer recommends that all women routinely perform BSE, the Society still promotes breast awareness and encourages women to be aware of the normal look and feel of their breasts. Studies have suggested that women usually find cancer while showering, bathing, or dressing, rather than during a specific breast examination. Unfortunately, mammography is not foolproof. Even under ideal conditions, it will not detect all breast cancers 100% of the time.”

Question 19

“Which of the following are methods used in BSE?
1.Using the pads of the three middle fingers to palpate the entire breast
2.Palpating around the breast in a vertical pattern
3.Using varying degrees of pressure while palpating of the breast
(A)1 only
(B)1 and 2 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 19

“(D) Three different levels of pressure are recommended when examining the breast: light pressure to feel the tissues closest to the skin, medium pressure to feel a little deeper, and firm pressure to feel the tissue closest to the chest and ribs. The up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for examining the entire breast without missing any breast tissue, and the pads of the three middle fingers (not the fingertips) are the most sensitive to palpate for abnormalities. The patient should use small dime-sized circular motions to examine the entire breast.”

Question 20

“For a menstruating woman, when is the best time of the month to perform BSE?
(A)One week before the start of menstruation
(B)On the first day of the month
(C)On the last day of the month
(D)One week after the menstrual cycle ends”

Answer 20

“(D) The patient should perform BSE 5 to 10 days after the start of the menstrual period or when the breasts are not tender or swollen.”

Question 21

“Which of the following statements are true?
1.Breast cancer death rates in the United States are going down
2.Breast cancer is the leading cause of cancer-related deaths among women in the United States
3.The second leading cause of cancer-related deaths among women in the United States is breast cancer
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 21

“C) Breast cancer is the second most common cancer among women in the United States. Certain types of skin cancer are the most common. Breast cancer is also the second most common cause of cancer-related deaths among women. (Lung cancer is the leading cause of cancer-related deaths among women in the United States.) Breast cancer incidence and death rates generally increase with advancing age. Breast cancer death rates have been declining since 1989—with larger decreases among the women aged 50 years and younger. Seventy-nine percent of new cases and 88% of breast cancer deaths occurred in the women aged 50 years and older. The decrease in the incidence of breast cancer is considered to be related to the reduced use of HRT after the study results published by the Women’s Health Initiative in 2002, which linked HRT to breast cancer risks. The decrease in breast cancer deaths is considered to be the result of advanced treatment options, earlier detection, and increased awareness.”

Question 22

“Postmenopausal obesity is associated with
(A)a relatively high risk of developing breast cancer
(B)overall reduction in breast cancer risks
(C)circulating estrogen that is produced in fatty tissue
(D)a lower overall estrogen level”

Answer 22

“C) Circulating estrogen is mostly produced in fatty tissue; therefore, in postmenopausal women, having more fatty tissue can lead to increased estrogen levels. Weight gain is, therefore, associated with increased estrogen levels and increased likelihood of developing breast cancer. Overweight or obesity, especially after menopause, increases the breast cancer risk. However, it is not a major risk factor.”

Question 23

“In routine mammography, the glandular dose per projection is generally approximately
(A)1 to 2 mGy (0.1–0.2 rad)
(B)10 to 20 mGy (1.0–2.0 rad)
(C)0.1 to 0.2 mGy (0.01–0.02 rad)
(D)2 to 3 mGy (0.2–0.3 rad)”

Answer 23

“(A) With modern mammography equipment, the patient usually receives only about 1 to 2 mGy (0.1–0.2 rad) per projection. ACR recommends that the average glandular dose on mammography should be no more than 3 mGy (0.3 rad or 300 mrad) with a grid, or 1 mGy (0.1 rad or 100 mrad) without a grid.”

Question 24

“Which of the following age groups is likely to get the most radiation dose during mammography?
(A)20 to 35 years
(B)40 to 50 years
(C)55 to 60 years
(D)Older than 70 years”

Answer 24

“(A) Although breast tissue composition is affected by menarche, hormonal fluctuation (both normal and synthetic), pregnancy, lactation, menopause, and weight gain or loss, the breasts of young women in general are denser than those of older women. Breasts of younger women, therefore, require more radiation to penetrate and absorb more radiation compared with those of older women. Fortunately, the incidence of breast cancer in this age group is very low.”

Question 25

“Approximately what percentage of women will be diagnosed with breast cancer in their lifetime?
(A)5%
(B)10%
(C)13%
(D)20%”

Answer 25

“C) Approximately 13% (12.8%) or 1 in 8 women will be diagnosed with breast cancer in their lifetime. Approximately 1 of every 100 breast cancers diagnosed in the United States is found in men. Approximately 1 in 39 or 3% of women will die from breast cancer.”

Question 26

“During mammography, which of the following will affect the average glandular dose per breast?
1.Degree of breast compression
2.The half-value layer (HVL) of the x-ray beam
3.Breast size and composition
(A)1 only
(B)2 only
(C)3 only
(D)1, 2, and 3”

Answer 26

“(D) The major factors affecting dose are as follows:
*The imaging chain—imaging conditions, including the type of mammography unit.
*The x-ray beam energy—the higher the peak kilovoltage (kVp) and HVL, the lower is the patient dose.
*The compression—higher compression results in decreased exposure, and therefore decreased dose.
*The patient’s breast tissue type (composition) and thickness—denser glandular breast requires more exposure compared with fattier breast.”

Question 27

“Patients who are allowed to play an active role in applying compression are usually
1.less likely to tolerate the compression
2.more likely to tolerate the compression
3.more relaxed during the compression
(A)1 only
(B)2 only
(C)1 and 3 only
(D)2 and 3 only

Answer 27

“(D) Studies have shown that a patient who plays an active role in applying compression will be able to tolerate the compression better and will be more relaxed during the compression. The more the patient knows about compression and understands the procedure, the more she will be relaxed. To give the patient an active role in compression, the technologist can allow the patient to apply the compression or constantly monitor the patient, stopping the compression when indicated by the patient. If the sensitivity is extreme and/or hormone related, mammography could be rescheduled.”

Question 28

“In breast imaging, the dose calculation is based on
(A)the entrance skin dose
(B)dose absorbed by the glandular tissue of the breast
(C)the average skin dose
(D)chest wall radiation dose”

Answer 28

“(B) The radiation dose in mammography is calculated on the basis of the average dose to the interior of the breast or the average glandular dose. In mammography, the glandular dose is very low compared with the skin dose because the dose falls off rapidly as the low photon energy beam penetrates the breast.
*ESE for a typical single exposure ≈800 to 1200 mrad (812 mGy); glandular dose during a typical mammogram exposure ≈100 mrad (1.0 mGy)
*ACR recommends
*0.3 rad (300 mrad or 3 mGy) with a grid
*0.1 rad (100 mrad or 1 mGy) without a grid”

Question 29

“What is the purpose of requesting the patient to provide prior mammograms before starting the mammogram examination?
(A)To check whether the patient has breast cancer
(B)To assess the exposure technique
(C)To provide the radiologist with an additional aid
(D)To verify the correct patient”

Answer 29

“(C) The previous mammogram cannot be used to verify the patient’s identity. With digital imaging, most mammography units offer an option for automatic exposure; therefore, assessment of the exposure technique is not needed for routine imaging. However, previous mammograms are invaluable to the radiologist and can help avoid false-positive or false-negative reports. Having the previous mammogram can lead to a more accurate reading and reduce the need for callbacks.”

Question 30

“The age of a woman undergoing HRT is likely to be
(A)less than 40 years
(B)25 to 35 years
(C)more than 40 years
(D)less than 20 years”

Answer 30

“(C) Decline in a woman’s hormone levels as a result of aging or menopause can result in uncomfortable symptoms, such as hot flashes, vaginal dryness, or osteoporosis. HRT uses estrogen and progesterone to treat these common symptoms. A woman undergoing HRT is, therefore, likely to be older than 40 years.”

Question 31

“The term primipara refers to a woman who
(A)has had multiple pregnancies
(B)was pregnant once but lost the baby at 6 weeks
(C)has given birth once
(D)was never pregnant”

Answer 31

“(C) A woman who has had one pregnancy with the fetus attaining a weight of 500 g or a gestational age of 20 weeks, regardless of the pregnancy culminating in a live birth or in a single birth or multiple births, is considered a primipara—the status of having borne one child. A nullipara is a woman who has never borne a child or carried a fetus to the point of viability.”

Question 32

“In mammography, information included on the medical history documentation includes which of the following as they relate to the breast?
1.Patient’s history of trauma
2.History of surgery
3.Unusual skin condition
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 32

“(D) The technologist should document a full clinical history, including family or personal history of breast cancer, any history of breast trauma, and history of breast surgery, biopsy, lumpectomy, and augmentation or reduction. Symptoms to document include skin thickening, unusual lumps, dimpling or puckering of skin, moles, eczema, ulcers, nipple changes—especially new changes—and any abnormalities of accessory breast tissue or nipples. It is also important to use the correct breast marker to help the radiologist to localize the abnormality (Fig. 1–3).”

Question 33

“All of the following are forms of subjective patient data, except
(A)the patient has a palpable lump in the right breast
(B)the patient complains of severe pain during breast compression
(C)the mood or demeanor of the patient
(D)the patient complains of pain and tenderness in the left breast”

Answer 33

“(A) Objective data include signs that can be seen, heard, or felt and other factors such as laboratory reports. Subjective data include symptoms that are perceived by the affected individual only (e.g., pain). Both objective and subjective data are equally important, and the technologist should never disregard anything that the patient says, even if it does not align with standard opinions or the patient’s symptoms.”

Question 34

“When questioning a patient to obtain an accurate patient history
(A)keep questions general in nature so as not to offend the patient
(B)start with open-ended questions and then follow up with more direct inquiries
(C)do not let the patient talk too much to keep the examination moving
(D)use medical “jargon” to impress the patient with your expertise”

Answer 34

“(B) The best approach to clinical history documentation is to start with open-ended questions. This avoids leading the patient and inserting the technologist’s opinions or views. Example of a leading question: “Is the pain in your right breast?” Example of a nonleading question: “Where is the pain?” In addition, listening rather than asking questions allows the patient to tell her stories voluntarily. By listening, the patient’s life experience and educational background can be assessed. This determines whether the medical or technical terms can be used rather than highly simplified words in future questions.”

Question 35

“Which of the following are positive questioning skills that the technologist can use when verifying the accuracy of patient information?
(A)Leading questions
(B)Open-ended questions
(C)Repeating information
(D)Facilitation”

Answer 35

“C) Repeating or rewording the question helps clarify the information and verify that the patient has not changed her mind. Open-ended questions are asked at the start of documentation of medical history to avoid leading the patient to only some answers. Leading questions should never be asked at the start of any assessment because their use can insert the technologist’s personal bias into the patient’s answers. Facilitation encourages elaboration.”

Question 36

“What is the purpose of “probing” questions when interviewing patients?
(A)Clarifies information by asking for specific details
(B)Gives the patient time to remember details
(C)Allows the patient time to tell her story
(D)Summarizes the accuracy of the information”

Answer 36

“(A) Probing questions are asked to get more details. Listening rather than asking questions allows the patient time to tell her stories voluntarily. Silence also gives the patient time to remember past events. Repetition, rewording, or summarization of the question can be used to review the information and verify accuracy.”

Question 37

“In gathering more information about a patient’s complaint of pain, a good probing question to ask would be
(A)“How would you describe the pain?”
(B)“When did the pain first occur?”
(C)“If the pain comes and goes, how often does it occur?”
(D)all of the above are good questions to ask”

Answer 37

“(C) Options (A) and (B) are good open-ended questions that can be asked to start documentation of clinical history. These avoid leading the patient to certain answers and inserting the technologist’s opinions or views. Option (C) is a probing question that could be asked to get more details.”

Question 38

“There are two types of data collection processes. If the patient says that she has a bruise on the left breast, this information is regarded as
(A)objective
(B)subjective
(C)open-ended scenario
(D)probing”

Answer 38

“(A) Objective data include signs that can be seen, heard, or felt, as well as laboratory reports. Subjective data include symptoms that are perceived only by the affected individual (e.g., pain). Both objective and subjective data are equally important, and the technologist should never disregard anything that the patient says, even if it does not align with standard opinions or the patient’s symptoms. Open-ended questions are questions that can be asked to start documentation of clinical history. These avoid leading the patient to certain answers and inserting the technologist’s opinions or views. A probing question is asked to get more details.”

Question 39

“What is the purpose of repetition when questioning the patient?
(A)To give the patient time to remember details
(B)To get more details
(C)To summarize
(D)To allow the patient to tell her story”

Answer 39

“(C) Repetition, rewording, or summarization of the question can be used to review the information and verify accuracy or clarify the information. While repeating information, precise and clear words must always be used because words do not always mean the same to the patients as they do to the technologist; for example, to the patient, “lumpectomy” can mean the removal of any lump from the breast, yet the medical meaning is removal of a cancerous lump. Probing questions are asked to get more details. Listening rather than asking questions allows the patient time to tell her stories voluntarily. Silence also gives the patient time to remember past events.”

Question 40

“Where is your pain?” is an example of
(A)a probing question
(B)repetition
(C)summarization
(D)an open-ended question”

Answer 40

“(D) This is an open-ended question that can be asked to start documentation of clinical history. This avoids leading the patient to certain answers and inserting the technologist’s opinions or views. A probing question is asked to get more details. Repetition, rewording, or summarization of the question can be used to review the information and verify accuracy or clarify the information.”

Question 41

“Which of the following will not result in increased breast cancer risks?
(A)Having a mother who took diethylstilbestrol (DES) while pregnant
(B)Having the first child before the age of 30 years
(C)History of Hodgkin’s lymphoma
(D)Menarche at the age of 10 years”

Answer 41

“(B) Pregnancy is considered to have a protective effect against breast cancer, and the longer a woman goes without getting pregnant, the higher are the risks. Pregnancy at an earlier age is, therefore, beneficial. Starting menstruation early (before the age of 12 years) is considered to increase the risk because it increases the number of menstrual cycles in a woman’s lifetime. Treatment for Hodgkin’s lymphoma can often require radiation to the chest area, which can result in increased breast cancer risk in later years.”

Question 42

“Approximately how many women will be diagnosed with invasive breast cancer each year?
(A)1,898,160
(B)608,570
(C)268,600
(D)300,600”

Answer 42

“(C) In 2019, approximately 268,600 cases of invasive breast cancer were diagnosed in women. Approximately 42,000 women died from breast cancer in 2019.”

Question 43

“Methods of acknowledging the patient and treating the patient courteously can include all of the following, except
(A)using greetings (good morning, good afternoon, etc.)
(B)avoiding eye contact
(C)giving your full attention
(D)introducing yourself”

Answer 43

“(B) All of the options except (B) are recommended. Technologists should maintain eye contact or smile and use appropriate language when greeting the patients.”

Question 44

“Two disadvantages specifically related to 2D mammography screening include
1.the glandularity of the breast can impact visualization of cancers
2.mammography will not image all cancers
3.the radiation dose from mammography is dangerous
(A)1 and 3 only
(B)1 and 2 only
(C)2 and 3 only”

Answer 44

“(B) The average glandular dose for typical mammography is regulated by the MQSA standards and is not considered dangerous. ACR recommends that the average glandular dose on a single projection should not be more than 3 mGy (0.3 rad or 300 mrad) with a grid, or 1 mGy (0.1 rad or 100 mrad) without a grid. All modern 2D and 3D digital units operate within these guidelines. The disadvantage of 2D mammography is related to the fact that a cancerous lesion will be imaged against the background breast tissue composition. In an all-fatty breast, it is easy to visualize the cancer. In dense, glandular breast tissue, it becomes harder to visualize the cancer. This means that mammography may not be 100% effective in diagnosing breast cancer. The good news is that 3D imaging and the use of adjunctive imaging modalities improve the true-positive rate.”

Question 45

“The glandular dose is
(A)received on the skin of the breast
(B)the significant background dose recorded by ultrasonography
(C)associated with dose to the radiosensitive cells of the breast
(D)a record of the dose to the gonads”

Answer 45

“C) Most reports of patient dose in radiology involve a fact check of only the ESE. However, the biological effect of mammography is assumed to be more closely associated with the total energy absorbed by the glandular tissue of the breast. This glandular dose is, therefore, the dose of choice when calculating radiation doses associated with mammography. In mammography, the glandular dose is very low compared with the skin dose because the dose falls off rapidly as the low photon energy beam penetrates the breast. The average glandular dose for typical mammography is regulated by the MQSA standards. ACR recommends that the average glandular dose on a single projection should not exceed 3 mGy (0.3 rad or 300 mrad) with a grid, or 1 mGy (0.1 rad or 100 mrad) without a grid.”

Question 46

“Having a dense breast will
(A)increase the risk of developing breast cancer
(B)reduce the risk of developing breast cancer
(C)result in breast cancer
(D)help combat breast cancer”

Answer 46

“(A) Women with dense breast tissue face a higher risk of missed breast cancer if mammography is the only screening tool used. Recent studies are leaning toward breast tissue density being a factor in breast cancer risks in younger women. The reason is that breast cancers tend to develop in dense breast tissue. If a woman has dense breast tissue, she has a higher risk of developing breast cancer compared with a woman of the same age with fatty breast tissue. Breast ultrasonography, digital mammography, and MRI are more accurate than mammography for assessing tumor size in breasts with a higher tissue density.”

Question 47

“The technologist should review the previous mammography report to
(A)verify the physician’s signature
(B)verify the technologist’s initials
(C)provide the radiologist with an additional aid
(D)confirm the type of examination (screening or diagnostic) needed”

Answer 47

“(D) The technologist can benefit by having access to previous mammograms if the patient has any limitations, either physical or mental, that will need to be addressed. The report on the previous mammogram will also verify the need for screening, short-interval follow-up, or diagnostic mammography. For insurance purposes, the previous mammogram and report will confirm whether the patient’s screening interval is correct—for example, to confirm that the last mammogram was, indeed, taken 1 year ago.”

Question 48

“Why should the patient wipe off deodorant before mammography?
(A)Deodorant can mimic malignant calcifications
(B)Deodorant causes breast cancer
(C)Deodorant blocks the lymph nodes and allows the spread of cancer
(D)Technologists face difficulty positioning the patients who have put on deodorant”

Answer 48

“(A) Mammography uses low-dose radiation to image the breast, and many deodorants and body powders contain aluminum or other metallic elements that are not easily penetrated by the low-peak kVp used in breast imaging. This means that the specks of aluminum or other metals will appear on the mammogram and can mimic microcalcifications. Certain types of breast cancer also appear on the mammogram as microcalcifications; therefore, the patient is advised not to put on any deodorant to avoid confusion (Fig. 1–4).”

Question 49

“A side effect of tamoxifen treatment is
(A)Breast cancer
(B)Pelvic inflammatory disease
(C)Brain cancer
(D)Uterine cancer”

Answer 49

“(D) Tamoxifen reacts with the estrogen receptors in other areas of the body, such as bone and the lining of the uterus. With the cells in these areas, tamoxifen acts like estrogen to promote growth, leading to increased bone density and a higher risk of developing uterine cancer. Other side effects of tamoxifen include endometrial cancer, pulmonary embolism, stroke, and deep vein thrombosis. Tamoxifen can also cause milder reactions, such as tiredness, dizziness, weight gain, and visual problems (e.g., blurred or reduced vision).”

Question 50

“Lumpectomy” describes the process of
(A)removing the entire breast, including the nipple
(B)removing the breast cancer tumor and margins of surrounding normal breast tissue
(C)making a small incision over or near the site of the breast lesion
(D)removing benign lumps from the breast”

Answer 50

“(B) Lumpectomy is a breast-conserving surgery, in which the breast tumor and surrounding margin of normal tissue are removed. Lumpectomy does not refer to removal of a benign lump. The main advantage of a lumpectomy is that it preserves most of the breast cosmetically. Factors that can affect the choice of lumpectomy over mastectomy include past lumpectomy, tumor size, tumor type, and cancer stage.”

Question 51

“Radiation therapy can be used
1.with other treatment options
2.to kill any remaining cancer cells in the breast or the chest wall area
3.to shrink a tumor before surgery
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 51

“(D) Radiation will kill both normal and cancerous cells. In any radiation treatment, the cell cycle is important because radiation usually works best on cells that are actively or rapidly dividing but does not work well on cells that are in the resting phase (G0) or are dividing slowly. Radiation is often used after the surgery and in conjunction with other treatment options to remove any remaining cancer cells in the breast, chest wall, and axilla but can be used before the surgery to shrink the tumor and allow a better cosmetic surgical result.”

Question 52

“Chemotherapy can be used to
(A)kill cancer cells in other parts of the body
(B)block estrogen from cancer cells
(C)reduce estrogen levels in the body
(D)kill cancer cells by using high-energy radiation”

Answer 52

“(A) Chemotherapy is an adjuvant therapy and involves the use of drugs to kill cancer cells and treat cancer that may have spread beyond the breast. The drug is distributed through the entire body via the bloodstream and tends to attack cells that are rapidly dividing, irrespective of whether they are cancerous. Drugs that block estrogen from latching onto cancer cells are antiestrogen drugs, such as tamoxifen and raloxifene. Another class of drugs—aromatase inhibitors—that suppresses blood levels of estrogen is also available to fight breast cancer. Radiation therapy uses high-energy radiation to destroy cancer cells.”

Question 53

“Breast reconstruction can involve the placement of small fluid-filled sacs behind the pectoral muscle. Two common types of such implants are
(A)saline and flap surgery
(B)TRAM flap and silicone implant
(C)silicone or saline implants
(D)saline-filled implant and latissimus dorsi flap implant”

Answer 53

“(C) Breast reconstruction can involve the placement of saline- or silicone-filled sacs either in front of or behind the pectoral muscle. Implants placed behind the pectoral muscle (subpectoral or retropectoral placement) are becoming more popular than the implants placed in front of the pectoral muscle (subglandular or retromammary placement), which is the older method. Subpectoral placement allows easier imaging of the breast mammographically and is less prone to encapsulation. Flap surgery uses skin, fat, or muscle from other parts of the body to form a natural-looking breast mound (Fig. 1–5).”

Question 54

“Chemotherapy
(A)involves the use of drugs to treat cancer that may have spread
(B)is the destruction of cancer cells by using estrogen receptor drugs
(C)involves mapping the area around a tumor with the injection of a radioactive tracer
(D)is the removal of the cancerous tissue from the breast”

Answer 54

“(A) Chemotherapy involves the use of drugs to kill cancer cells that may have spread beyond the breast. It can also be used to slow the growth of cancer or to relieve the symptoms of cancer. The chemotherapy treatments may last 3 to 6 months, depending on the strength of the chemotherapy drug and how far the cancer has spread. Generally, chemotherapy treatment is given in cycles, with a period of treatment followed by a recovery period.”

Question 55

“A process of removing tissue and fat from the abdomen and transferring that tissue and fat to reconstruct the breast is called
(A)deep inferior epigastric perforator (DIEP) flap
(B)latissimus dorsi flap
(C)transverse rectus abdominus myocutaneous (TRAM) flap
(D)transverse upper gracilis (TUG) flap

Answer 55

“(A) In DIEP flap procedure, skin and fat from the abdomen are used to reconstruct a breast after mastectomy. Unlike the TRAM flap procedure, the DIEP flap procedure does not take any abdominal muscles. However, the tissue being completely removed, microsurgery is needed to connect the blood vessels. The TRAM flap procedure uses tissue and muscle from the lower abdominal wall to create a breast shape. There are two types of TRAM flaps: the pedicle flap, where the flap is left with its original blood supply and tunneled under the skin to the breast area; and the free flap, where the tissue from the abdomen is completely removed from its original location. The TRAM flap procedure requires microscopic surgery to reconnect the blood supply. This procedure leaves weak abdominal muscles and is no longer popular. The latissimus dorsi flap procedure involves the removal of muscle and skin from the upper back to create a breast shape. The TUG flap procedure uses tissue from the inner upper thigh, near the crease of the groin, as well as some muscle to create breast tissue. This is not a common procedure, and it is only performed if the patient does not have[…]”

Question 56

“Antiestrogen drugs, such as tamoxifen, can be used to
1.slow or stop the growth of cancer
2.prevent breast cancer in high-risk women
3.prevent the recurrence of breast cancer
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 56

“(D) Tamoxifen belongs to a class of drugs called SERMs. Normally, the estrogen receptor molecules in the cancer cells react with estrogen in the body, allowing the cells to grow. Antiestrogen drugs work by attaching to the estrogen receptor molecule in the breast cancer cells that would normally react with estrogen. This prevents the estrogen receptor cancer cells from interacting with estrogen and can slow or stop the cancer’s growth. It can also be used to prevent breast cancer or the recurrence of breast cancer at local sites or distant metastasis after a lumpectomy or radiation treatment.”

Question 57

“The most common immunohistochemical (IHC) tumor marker is
(A)progesterone receptor–negative
(B)estrogen receptor–positive
(C)estrogen receptor–negative
(D)progesterone receptor–positive”

Answer 57

“(B) Breast tumors are currently classified by using five IHC tumor markers: estrogen receptor (ER-positive), progesterone receptor (PR-positive), human epidermal growth factor receptor 2 (HER2), HER1, and cytokeratin 5/6 (CK 5/6). Estrogen receptor–positive (ER-positive) breast tumors are the most common in the United States.”

Question 58

“A process by which the breast size is increased by using implants is called
(A)augmentation mammoplasty
(B)lumpectomy
(C)needle biopsy
(D)needle aspiration”

Answer 58

“(A) In the process of breast augmentation, silicone- or saline-filled sacs are inserted into the breasts to increase the breast size. Needle biopsy involves removing cell or tissue samples from the breasts for testing. Needle aspiration involves removing fluid from a cyst for testing. Lumpectomy involves the removal of the malignant tumor and the margins of the surrounding normal breast tissue.”

Question 59

“The removal of one to three axillary nodes for testing is included in a/an
(A)axillary node dissection
(B)sentinel node mapping
(C)sentinel node biopsy
(D)lumpectomy”

Answer 59

“(C) Sentinel node mapping involves injecting a radiopharmaceutical into the subareolar lymphatic plexus (or lesion). The tracer travels to the sentinel node—identifying that node for dissection and eliminating the need for extensive lymph node dissection. Sentinel node biopsy involves the removal of the sentinel lymph node plus two to three more adjacent nodes for testing. Lumpectomy is the removal of the tumor plus surrounding margins. Axillary node dissection is the removal of most of the lymph nodes from the axilla for testing.”

Question 60

“Which of the following are side effects of radiation treatment?
1.Loss of appetite
2.Fatigue
3.Heaviness of the breast
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 60

“(D) The side effects of radiation are often temporary and can include fatigue, swelling of the breast, heaviness in the breast, sunburn-type appearance of the breast skin, loss of appetite, and neutropenia, which is a decrease in WBC count. Most side effects disappear after 6 to 12 months.”

Question 61

“A big advantage of brachytherapy over traditional radiation therapy treatments is
(A)reduced time of treatment
(B)ability of brachytherapy to treat larger tumors
(C)ability to give more radiation to healthy tissue
(D)more convenience because of the longer treatment times”

Answer 61

“(A) Brachytherapy can deliver a high dose of radiation to small areas. Instead of radiation coming from outside of the body, the active source is temporarily placed directly in the body or tumor cavity. There are a number of methods. One method is called seed implantation brachytherapy, in which the radioactive seeds are placed directly in the breast tissue where the cancer was removed. First, 10 to 20 plastic catheters are surgically placed into the breast tissues. Then, radioactive pellets—iridium-192—are inserted into the catheters. The catheters are connected to a high-dose rate brachytherapy machine nine or more times in a week for approximately 10 minutes. The catheters are removed after the treatment. In this method, the source of radiation remains in the patient’s body between the treatments. Another method involves surgically implanting an inflatable balloon catheter device at the site of the tumor. The device remains in place for the duration of the treatment, but at each treatment session, a tiny radioactive bead attached to a wire is threaded into the inflated balloon. The wire device is moved to various sites inside the inflated balloon delivering different levels of radiation. After completion of treatment, the[…]”

Question 62

“The side effects of chemotherapy include
(A)hair regrowth
(B)increase white cell count
(C)increase appetite
(D)low red blood cell count”

Answer 62

“(D) The side effects of chemotherapy vary depending on the strength of the drugs used, the dosage, and the duration of treatment. Some patients experience few side effects; others experience many of the common side effects, which include:
*Alopecia (hair loss), which is generally temporary and occurs in some women because the hair follicles are weakened by the chemotherapy drug, causing hair to fall out at a much faster rate than that of normal hair growth (most hair loss will not begin until after the second chemotherapy session, and hair grows back at the end of treatment—sometimes with a change in texture)
*Irritation of the lining of the stomach or intestine, which can cause nausea and vomiting
*Mouth sores and taste changes
*Decreased appetite; diarrhea or constipation
*Infertility or premature menopause (the closer the woman is to menopause when she undergoes chemotherapy, the more likely she is to experience premature menopause)
*Birth defects, if undergoing chemotherapy when pregnant
*Tingling or burning sensations and numbness in hands and/or feet
*Skin irritations—redness, itching, peeling, or acne
*Dark brittle or cracked fingernails and/or toenails
*Low blood cell (WBCs, red blood cells [RBCs], or platelets) counts (A low WBC[…]”

Question 63

“What is tamoxifen treatment?
(A)An adjuvant therapy by using drugs to reduce the risk of developing certain cancers
(B)A drug regimen that effectively blocks certain hormones in the body
(C)An external method of killing cancer cells
(D)The removal of all cancer cells from the body, thereby reducing cancer risks”

Answer 63

“(A) Tamoxifen has been used since the 1970s to treat patients with estrogen receptor–positive (ER-positive) breast cancer. It is considered an antiestrogen drug that blocks estrogen and can lower the risk of breast cancer recurrence in postmenopausal women. The other techniques remove tissue, core samples, for histological analysis.”

Question 64

“Cosmetic intervention” is
1.breast reconstruction after the treatment for breast cancer
2.surgical reconstruction of the breast at the patient’s request
3.breast augmentation for personal reasons
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 64

“(B) Cosmetic intervention is a selective treatment requested by the patient for a variety of reasons. The treatment can be breast augmentation or reduction. A required treatment for medical problems or breast cancer is not considered a cosmetic intervention.”

Question 65

“The side effects of chemotherapy are related to the effect of the drug on
(A)all tissues and organs in the body
(B)cancer cells only
(C)the growth of cancer
(D)hair follicles only”

Answer 65

“(A) Chemotherapy is an adjuvant therapy and involves the use of drugs to treat cancer that may have spread beyond the breast. The drug is distributed through the entire body via the bloodstream and tends to attack cells that are rapidly dividing, irrespective of whether they are cancerous. The side effects of chemotherapy vary depending on the strength and type of the drugs used, the dosage, and the duration of treatment.”

Question 66

“A surgical treatment procedure that removes the breast tissue, skin, nipple, and areola but leaves the lymph nodes intact is called
(A)simple mastectomy
(B)nipple-sparing mastectomy
(C)prophylactic mastectomy
(D)modified mastectomy”

Answer 66

“(A) Simple mastectomy involves the removal of breast tissue, skin, nipple, and areola but leaves most of the lymph nodes intact. Modified radical mastectomy involves the removal of the entire breast, including the nipple–areolar region and some of the underarm lymph nodes. After a mastectomy, the patient may request cosmetic intervention. A cosmetic intervention is a selective treatment where the remaining breast may be augmented or reduced. Nipple-sparing mastectomy involves the removal of the breast tissue, but the nipple–areola complex is spared. This procedure can be performed in women with relatively small tumors or nonaggressive cancers or as a prophylactic procedure. Prophylactic mastectomy involves the removal of a healthy breast when the individual has a high-risk factor for developing breast cancer. All the breast tissue, including the nipple–areolar region, may be removed. Alternatively, nipple-sparing mastectomy may be performed. A surgery performed because of cosmetic reasons is not related to the medical problems or breast cancer.

Question 67

“Which of the following are contraindications for lumpectomy?
1.Previous lumpectomy
2.Multiple cancer sites in one breast
3.Large tumors in a small breast
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 67

“(D) Lumpectomy is only possible with small tumors, and there are numerous critical considerations. Women with large tumors in small breasts will have poor cosmetic results or will suffer from breast deformity. The type and stage of the cancer could be contraindications for lumpectomy. Other contraindications can include multifocal cancers located at multiple sites within a single duct; multicentric cancers located within multiple ducts; previous radiation to the breast/chest area precluding additional radiation treatment; previous lumpectomy in which the cancer was not completely removed; connective tissue diseases, such as scleroderma, osteoarthritis, or rheumatoid arthritis, which may involve tissues that are sensitive to radiation or pregnancy, if radiation therapy is indicated.”

Question 68

“The staging of cancer determines
1.whether the cancer is invasive
2.the exact tumor size
3.whether the cancer has spread to distant sites
(A)1 and 2 only
(B)2 and 3 only
(C)1 and 3 only
(D)1, 2, and 3”

Answer 68

“(D) Staging finds out how widespread the cancer is. Breast cancer is staged on the basis of tumor size, lymph node status, and the presence or absence of distant metastases.”

Question 69

“Which of the following is a name given to the clear fluid that can sometime form and a complication to the mastectomy procedure?
(A)Hematoma
(B)Seroma
(C)Lymphoma
(D)Lymphedema”

Answer 69

“(B) Mastectomy generally proceeds normally for most of the patients; however, it is a surgical procedure, and there can be complications. As with any surgery, the patient can develop an infection that will require treatment, or clear fluid (seroma) can become trapped in the surgical site. The patient can also develop a hematoma, which is a collection of blood. However rarely seen, complications can cause the postsurgical healing process to be extended.”

Question 70

““Neoadjuvant chemotherapy” refers to the treatment
(A)before the surgery to help shrink cancerous tumors
(B)after the mastectomy to slow the growth of cancer
(C)before the surgery by using an antiestrogen drug
(D)after the surgery that involves radiation”

Answer 70

“(A) Neoadjuvant chemotherapy is administered before the surgery to slow the growth or shrink the cancerous tumor. Adjuvant chemotherapy is administered in addition to other treatments.”

Question 71

Answer 71

“Figure 1–1. There are four descriptors for breast density on mammography in the 5th edition of BI-RADS: (A) the breasts are almost entirely fatty; (B) there are scattered areas of fibroglandular density; (C) the breasts are heterogeneously dense, which may obscure small masses; and (D) the breasts are extremely dense, which lowers the sensitivity of mammography.”