Multiple Choice Questions (MCQs)
Epidemiology & Risk Factors
1. Which of the following genetic mutations is most strongly associated with hereditary
breast cancer?
A) TP53
B) BRCA1
C) PTEN
D) HER2
2. Which reproductive factor is least associated with an increased risk of breast cancer?
A) Early menarche
B) Late menopause
C) Multiparity
D) Hormone replacement therapy
3. Which subtype of breast cancer is more common in younger, African-American women
and has a poor prognosis?
A) Luminal A
B) Luminal B
C) HER2-enriched
D) Triple-negative
4. Which statement about male breast cancer is false?
A) BRCA2 mutations increase the risk
B) Gynecomastia is a major risk factor
C) It commonly presents with a painless mass
D) It accounts for less than 1% of all breast cancers
Pathophysiology & Molecular Biology
5. The most common histological subtype of invasive breast cancer is:
A) Lobular carcinoma
B) Ductal carcinoma
C) Mucinous carcinoma
D) Medullary carcinoma
6. Which of the following receptors is used to classify breast cancer subtypes?
A) EGFR
B) HER2, ER, PR
C) VEGF
D) PD-L1
7. In triple-negative breast cancer, which molecular pathway is most frequently altered?
A) PI3K/AKT/mTOR
B) Ras/Raf/MAPK
C) Wnt/β-catenin
D) JAK/STAT
Clinical Presentation & Diagnosis
8. Which clinical feature is most suggestive of inflammatory breast cancer?
A) Peau d’orange appearance
B) A well-circumscribed mobile mass
C) Nipple discharge that is clear
D) A slow-growing lump in the upper outer quadrant
9. The most sensitive imaging modality for detecting breast cancer in high-risk women with
dense breasts is:
A) Digital mammography
B) Ultrasound
C) MRI
D) CT scan
10. Which biopsy method provides the most accurate histological diagnosis of breast
cancer?
A) Fine-needle aspiration (FNA)
B) Core needle biopsy
C) Excisional biopsy
D) Incisional biopsy
Staging & Prognosis
11. According to the TNM staging system, which feature upgrades a tumor to stage III?
A) Tumor size >2 cm
B) Metastasis to ipsilateral axillary lymph nodes
C) Invasion into the chest wall or skin
D) Distant metastasis
12. Which prognostic factor is considered the most significant in predicting breast cancer
survival?
A) Tumor size
B) Lymph node involvement
C) Histological grade
D) ER/PR status
Treatment & Management
13. In a premenopausal woman with ER-positive, HER2-negative breast cancer, which
adjuvant therapy is most appropriate?
A) Aromatase inhibitor
B) Tamoxifen
C) Trastuzumab
D) Bevacizumab
14. A 50-year-old woman with HER2-positive breast cancer is most likely to benefit from
which targeted therapy?
A) Tamoxifen
B) Bevacizumab
C) Trastuzumab
D) Palbociclib
15. Which chemotherapy regimen is commonly used in the neoadjuvant setting for breast
cancer?
A) FOLFOX
B) AC-T (Adriamycin + Cyclophosphamide followed by Taxane)
C) CHOP
D) XELOX
16. Which statement is false regarding breast-conserving surgery?
A) It is contraindicated in multicentric disease
B) It has the same survival rate as mastectomy when combined with radiation
C) Sentinel lymph node biopsy is required
D) It is preferred over mastectomy in BRCA1 mutation carriers
Complications & Survivorship
17. Which late complication is most associated with radiation therapy for breast cancer?
A) Pulmonary fibrosis
B) Secondary leukemia
C) Lymphedema
D) Myocardial infarction
18. A breast cancer survivor on tamoxifen should be monitored for:
A) Osteoporosis
B) Endometrial cancer
C) Cardiomyopathy
D) Hypercalcemia
19. Which lifestyle modification has the strongest evidence in reducing breast cancer
recurrence?
A) Vitamin D supplementation
B) Low-fat diet
C) Regular physical activity
D) Avoiding caffeine
20. Which type of breast cancer has the worst overall prognosis?
A) HER2-positive
B) Luminal B
C) Triple-negative
D) Mucinous carcinoma
Challenging Breast Cancer MCQs
1. Which of the following findings on mammography is most suggestive of malignancy?
A) Round, well-circumscribed mass
B) Clustered pleomorphic microcalcifications
C) Smooth, oval-shaped lesion with posterior enhancement
D) Cyst with central hyperechoic area
2. A 45-year-old woman with a history of BRCA1 mutation presents for breast cancer
screening. Which imaging modality is most appropriate for early detection?
A) Mammography alone
B) Ultrasound
C) MRI
D) CT scan
3. Which of the following histological subtypes of breast cancer is most likely to present
bilaterally?
A) Invasive Ductal Carcinoma
B) Invasive Lobular Carcinoma
C) Ductal Carcinoma In Situ (DCIS)
D) Medullary Carcinoma
4. A biopsy of a breast lesion reveals a well-circumscribed, painless, firm, and mobile mass
measuring 3 cm in a 22-year-old woman. What is the most likely diagnosis?
A) Fibroadenoma
B) Phyllodes tumor
C) Ductal Carcinoma In Situ
D) Fat necrosis
5. Which of the following molecular subtypes of breast cancer is the most aggressive and
has the worst prognosis?
A) Luminal A-like
B) Luminal B-like
C) HER2-enriched
D) Triple-negative
6. What is the most common route of metastasis for invasive ductal carcinoma?
A) Hematogenous to the brain
B) Lymphatic spread to axillary nodes
C) Direct invasion into the chest wall
D) Perineural invasion to the brachial plexus
7. A 50-year-old woman presents with nipple erythema, irritation, and a burning sensation.
Which breast cancer subtype is most likely?
A) Inflammatory breast cancer
B) Paget’s disease of the nipple
C) Triple-negative breast cancer
D) Phyllodes tumor
8. What is the first lymph node to which breast cancer is most likely to spread?
A) Internal mammary node
B) Sentinel lymph node
C) Clavicular lymph node
D) Mesenteric lymph node
9. Which histological feature differentiates invasive lobular carcinoma from invasive ductal
carcinoma?
A) Central necrosis
B) Single-file pattern of tumor cells
C) Microcalcifications on mammography
D) High mitotic index
10. What is the defining feature of ductal carcinoma in situ (DCIS) compared to invasive
ductal carcinoma?
A) Distorts ductal architecture
B) Presence of perineural invasion
C) Confined within the ductal basement membrane
D) Metastasizes via lymphatics
11. In TNM staging, which classification indicates a tumor that is more than 5 cm but has
not spread beyond the breast?
A) T1
B) T2
C) T3
D) T4
12. Which factor is NOT considered in treatment decisions for breast cancer?
A) Tumor grade
B) Patient’s eye color
C) Biomarkers (ER, PR, HER2)
D) Menopausal status
13. A patient diagnosed with a hormone receptor-positive breast cancer is started on
Tamoxifen. What is the primary mechanism of action?
A) HER2 receptor inhibition
B) Estrogen receptor blockade
C) Topoisomerase inhibition
D) DNA cross-linking
14. Which of the following is the best surgical approach for a small, localized breast tumor
with no lymph node involvement?
A) Radical mastectomy
B) Lumpectomy with sentinel node biopsy
C) Total mastectomy with axillary lymph node dissection
D) Bilateral mastectomy
15. What is the most important postoperative precaution for a patient who has undergone
axillary lymph node dissection?
A) Avoid washing the affected arm
B) Maintain the affected arm in an adducted position
C) Avoid injections and blood pressure measurements in the affected arm
D) Elevate the affected arm only at night
16. Which of the following features suggests a benign breast lesion rather than a malignant
one?
A) Poorly defined margins
B) Heterogeneous internal echoes
C) Central enhancement on ultrasound
D) Taller-than-wide shape
17. What is the primary purpose of a core needle biopsy in breast cancer diagnosis?
A) To remove the entire tumor
B) To differentiate between benign and malignant cells
C) To assess the lymph node involvement
D) To evaluate response to chemotherapy
18. A woman who underwent a mastectomy is advised to perform regular hand and arm
precautions. Which of the following should she AVOID?
A) Wearing loose-fitting clothing on the affected arm
B) Using a thimble while sewing
C) Carrying heavy objects with the affected arm
D) Wearing gloves while gardening
19. Which breast cancer molecular subtype is characterized by HER2 overexpression but
lacks hormone receptor positivity?
A) Triple-negative
B) HER2-enriched
C) Luminal A-like
D) Luminal B-like
20. A patient with inflammatory breast cancer is most likely to present with which of the
following signs?
A) Painless lump
B) Peau d’orange appearance
C) Clear nipple discharge
D) Unilateral breast enlargement with normal skin color
Answers
21. B) Clustered pleomorphic microcalcifications
22. C) MRI
23. B) Invasive Lobular Carcinoma
24. A) Fibroadenoma
25. D) Triple-negative
26. B) Lymphatic spread to axillary nodes
27. B) Paget’s disease of the nipple
28. B) Sentinel lymph node
29. B) Single-file pattern of tumor cells
30. C) Confined within the ductal basement membrane
31. C) T3
32. B) Patient’s eye color
33. B) Estrogen receptor blockade
34. B) Lumpectomy with sentinel node biopsy
35. C) Avoid injections and blood pressure measurements in the affected arm
36. C) Central enhancement on ultrasound
37. B) To differentiate between benign and malignant cells
38. C) Carrying heavy objects with the affected arm
39. B) HER2-enriched
40. B) Peau d’orange appearance
41.
Short-Answer Questions (SAQs)
1. Explain the role of the BRCA1 and BRCA2 genes in breast cancer pathogenesis.
2. Describe the molecular subtypes of breast cancer based on receptor status and their
implications for treatment.
3. A 45-year-old woman presents with a 2.5 cm mass in the upper outer quadrant of
her breast and axillary lymphadenopathy. Outline the key investigations required
for staging and treatment planning.
4. Compare and contrast neoadjuvant and adjuvant therapy in breast cancer,
including their advantages and indications.
