BREAST CANCER

Question 1

Which of the following factors is most strongly associated with an increased risk of breast cancer?
A) Late menopause
B) Early first full-term pregnancy
C) Long duration of maternal nursing
D) Early menarche

Answer 1

Answer: D) Early menarche
Rationale: Early menarche (<12 years) is associated with a longer lifetime exposure to endogenous estrogens, which increases the risk of breast cancer. In contrast, maternal nursing is protective, and early first full-term pregnancy reduces risk.

Risk of developing breast cancer
is higher in women with early menarche (<12 years) and late first fullterm
pregnancy (>35 years), and it is increased by exogenous hormone
replacement therapy.

Question 2

Which of the following is true regarding hormone replacement therapy (HRT) and breast cancer risk?
A) HRT with estrogen alone significantly increases breast cancer risk.
B) HRT with estrogen plus progestins doubles the risk of breast cancer after 6–7 years.
C) HRT reduces breast cancer risk if taken with progestins.
D) Discontinuation of HRT has no effect on breast cancer incidence.

Answer 2

Answer: B) HRT with estrogen plus progestins doubles the risk of breast cancer after 6–7 years.
Rationale: Combined estrogen and progestin HRT is associated with a significant increase in breast cancer risk and adverse cardiovascular events. Discontinuing HRT rapidly decreases the elevated incidence of breast cancer.

Question 3

Which of the following statements about alcohol and breast cancer is accurate?
A) Alcohol intake is protective against breast cancer.
B) Moderate alcohol intake increases breast cancer risk.
C) Folic acid supplementation negates the risk of alcohol consumption.
D) Heavy alcohol intake is associated with a reduced risk of breast cancer recurrence.

Answer 3

Answer: B) Moderate alcohol intake increases breast cancer risk.
Rationale: Moderate alcohol intake increases the risk of breast cancer by an unknown mechanism. Folic acid supplementation may modify risk in women who consume alcohol but is not protective for abstainers.

Question 4

Which of the following breast cancer risk factors is not supported by the provided information?
A) Central obesity
B) Radiation exposure after age 30
C) Moderate alcohol intake
D) Atypical hyperplasia

Answer 4

Answer: B) Radiation exposure after age 30
Rationale: Radiation exposure after age 30 has minimal carcinogenic effects on the breast, whereas exposure before age 30, particularly during adolescence, is associated with a substantial increase in risk. Central obesity, alcohol intake, and atypical hyperplasia are confirmed risk factors.

Question 5

Which group of women has a significantly reduced risk of breast cancer?
A) Women who receive combined estrogen and progestin HRT
B) Women who undergo early menopause and avoid HRT
C) Women exposed to mediastinal radiation before age 30
D) Women with atypical hyperplasia

Answer 5

Answer: B) Women who undergo early menopause and avoid HRT
Rationale: Early menopause reduces lifetime estrogen exposure and is protective against breast cancer. Avoiding HRT further minimizes risk.

Question 6

Which intervention reduces the risk of both breast and ovarian cancer in women with high genetic risk?
A) Chemoprevention with SERMs
B) Bilateral oophorectomy and salpingo-oophorectomy
C) Prophylactic bilateral mastectomy only
D) Avoidance of HRT

Answer 6

Answer: B) Bilateral oophorectomy and salpingo-oophorectomy
Rationale: Prophylactic removal of the ovaries and fallopian tubes reduces the risk of both breast and ovarian cancer in women with high genetic risk, such as those with BRCA1/2 mutations.

Question 7

Which of the following women would most likely benefit from prophylactic bilateral mastectomy?
A) A woman with a diagnosis of unilateral breast cancer
B) A woman with BRCA1 or BRCA2 mutations
C) A woman with a family history of breast cancer in one relative
D) A postmenopausal woman with ER-positive breast cancer

Answer 7

Answer: B) A woman with BRCA1 or BRCA2 mutations
Rationale: Women with BRCA1/2 mutations are at a significantly increased risk of breast cancer and may benefit from prophylactic bilateral mastectomy. This procedure is not typically recommended for women with average or mildly elevated risk.

Question 8

In which of the following situations is MRI recommended for breast cancer screening?
A) Women with normal mammographic findings
B) Women with particularly dense breasts
C) Women over 70 years of age with no family history of breast cancer
D) Women with no identifiable risk factors

Answer 8

Answer: B) Women with particularly dense breasts
Rationale: MRI is recommended for women with dense breast tissue because mammography can be less effective at detecting abnormalities in dense breasts. It is not recommended for routine screening in women with no identifiable risk factors or normal mammographic findings.

Question 9

Why might MRI be considered for women with a history of radiation therapy to the chest?
A) To monitor for metastasis in patients with a prior cancer diagnosis
B) Radiation exposure increases breast cancer risk, especially when administered between ages 10 and 30
C) MRI provides better imaging than mammography in all patients with a history of cancer treatment
D) MRI is less sensitive to scar tissue from prior radiation therapy

Answer 9

Answer: B) Radiation exposure increases breast cancer risk, especially when administered between ages 10 and 30
Rationale: Radiation therapy to the chest at a young age (10–30 years) significantly increases the risk of breast cancer, making MRI a valuable tool for enhanced surveillance in these patients.

Question 10

Which of the following features of a breast mass is most concerning for breast cancer?
A) Tenderness and cystic nature
B) Firmness, irregularity, and tethering to the underlying chest wall
C) Soft and mobile mass
D) A mass that changes with the menstrual cycle

Answer 10

Answer: B) Firmness, irregularity, and tethering to the underlying chest wall
Rationale: Features such as firmness, irregularity, tethering, or fixation to the chest wall are concerning for malignancy. In contrast, tenderness or cystic masses are less likely to be malignant.

Question 11

A postmenopausal woman presents with a dominant breast mass that has persisted for several weeks. What is the next step in her evaluation?
A) Monitor the mass for 3 months
B) Perform a mammogram and likely proceed to biopsy if necessary
C) Wait for the mass to change in size before acting
D) Recommend breast self-exams and schedule follow-up in 6 months

Answer 11

Answer: B) Perform a mammogram and likely proceed to biopsy if necessary
Rationale: A dominant mass in a postmenopausal woman warrants further evaluation, typically starting with a mammogram. If the mass remains suspicious, biopsy is often indicated for a definitive diagnosis.

Question 11

A patient presents with a palpable breast mass that is not suspicious on examination. What is the next best step for a premenopausal woman?
A) Perform a biopsy immediately
B) Reassess the mass after 2–4 weeks, during the follicular phase of the menstrual cycle
C) Order an immediate mammogram
D) Monitor the mass for 6 months

Answer 11

Answer: B) Reassess the mass after 2–4 weeks, during the follicular phase of the menstrual cycle
Rationale: In premenopausal women, it is recommended to reexamine a non-suspicious mass 2-4 weeks later during the follicular phase of the menstrual cycle (days 5-7) for a more accurate assessment.

Question 12

If a dominant breast mass develops during pregnancy or lactation, what is the recommended course of action?
A) Assume it is due to hormonal changes and avoid further testing
B) Conduct appropriate diagnostic evaluation to rule out malignancy
C) Delay any testing until after breastfeeding is finished
D) Wait 6 months before taking any action

Answer 12

Answer: B) Conduct appropriate diagnostic evaluation to rule out malignancy
Rationale: A dominant mass that develops during pregnancy or lactation should not be automatically attributed to hormonal changes. It requires proper diagnostic evaluation to rule out breast cancer or other potential causes.

Question 13

How does the prognosis of breast cancer in pregnant women compare to nonpregnant women?
A) Breast cancer in pregnant women has a better prognosis due to hormonal support
B) Breast cancer in pregnant women is the same as in premenopausal women but often more advanced due to delayed diagnosis
C) Pregnant women have a significantly worse prognosis due to the effects of pregnancy on treatment
D) There is no significant difference in the prognosis of breast cancer between pregnant and nonpregnant women

Answer 13

Answer: B) Breast cancer in pregnant women is the same as in premenopausal women but often more advanced due to delayed diagnosis
Rationale: While the stage and biological characteristics of breast cancer in pregnant women are similar to those in premenopausal nonpregnant women, pregnancy-related hormonal stimulation and delayed diagnosis can result in more advanced disease.

Question 14

What is a key feature of Luminal A breast cancers?
A) High levels of HER2 amplification
B) High-grade tumors with high proliferative activity
C) High levels of estrogen receptor (ER) and low levels of HER2
D) Expression of cytokeratins 5/6 and 17

Answer 14

Answer: C) High levels of estrogen receptor (ER) and low levels of HER2
Rationale: Luminal A tumors are characterized by high levels of ER, low HER2 amplification, and a generally favorable prognosis. They tend to be low grade with low proliferative activity.

Question 15

Which of the following is true regarding Luminal B breast cancers?
A) They are usually low grade and low proliferative
B) They tend to be HER2 positive and have higher proliferative activity than Luminal A tumors
C) They are almost universally ER-negative
D) They respond less well to chemotherapy than Luminal A tumors

Answer 15

Answer: B) They tend to be HER2 positive and have higher proliferative activity than Luminal A tumors
Rationale: Luminal B tumors are typically higher grade, have higher proliferative activity, may express low levels of HER2, and have a somewhat worse prognosis compared to Luminal A cancers.

Question 16

HER2-amplified breast cancers are characterized by:
A) Lack of HER2 amplification and low proliferative activity
B) Co-amplification and overexpression of HER2 and adjacent genes, with poor prognosis until the introduction of anti-HER2 therapies
C) High levels of ER and low-grade tumors
D) Expression of cytokeratins 5/6 and 17

Answer 16

Answer: B) Co-amplification and overexpression of HER2 and adjacent genes, with poor prognosis until the introduction of anti-HER2 therapies
Rationale: HER2-amplified breast cancers are characterized by the overexpression of HER2 and adjacent genes. These tumors historically had a poor prognosis, but the introduction of targeted therapies, such as trastuzumab, has significantly improved outcomes.

Question 17

Which of the following statements is true about basal (triple-negative) breast cancers?
A) They are characterized by high levels of ER and PgR expression
B) They express cytokeratins 5/6, 17, and other markers such as EGFR
C) They are almost always HER2-positive
D) They are low grade and have low proliferative activity

Answer 17

Answer: B) They express cytokeratins 5/6, 17, and other markers such as EGFR
Rationale: Basal or triple-negative breast cancers are typically ER/PgR-negative and HER2-negative. They are high grade and express markers such as cytokeratins 5/6, 17, and EGFR. They are often associated with germline BRCA1 mutations.

Question 18

Which of the following is the primary mechanism of action of tamoxifen in treating breast cancer?
A) Estrogen agonism in breast tissue
B) Estrogen antagonism in breast tissue and agonism in other tissues like bone and liver
C) Estrogen depletion through ovarian suppression
D) Inhibition of aromatase activity

Answer 18

Answer: B) Estrogen antagonism in breast tissue and agonism in other tissues like bone and liver
Rationale: Tamoxifen is a selective estrogen receptor modulator (SERM) that acts as an estrogen antagonist in breast tissue, inhibiting tumor growth, and as an estrogen agonist in other tissues such as bone and liver, providing protective effects against osteoporosis.

Question 19

What are the most common side effects of tamoxifen due to its estrogen antagonism?
A) Hot flashes, vaginal discomfort, myalgias, and arthralgias
B) Weight gain, hyperglycemia, and muscle cramps
C) Thrombosis and endometrial cancer
D) Osteopenia and osteoporosis

Answer 19

Answer: A) Hot flashes, vaginal discomfort, myalgias, and arthralgias
Rationale: The estrogen antagonistic effects of tamoxifen cause common side effects like hot flashes, vaginal discomfort, myalgias, and arthralgias, due to its action on estrogen receptors in various tissues.

Question 20

Which of the following is NOT a known toxicity of aromatase inhibitors (AIs)?
A) Hot flashes
B) Osteoporosis and fractures
C) Vaginal dryness and sexual dysfunction
D) Increased risk of endometrial cancer

Answer 20

Answer: D) Increased risk of endometrial cancer
Rationale: Aromatase inhibitors reduce circulating estrogen to nearly undetectable levels, causing hot flashes, osteoporosis, and sexual dysfunction, but they do not increase the risk of endometrial cancer, which is a known risk with tamoxifen due to its estrogen agonist effects in the uterus.

Question 21

What is the benefit of extending adjuvant endocrine therapy for an additional 5 years after the initial 5-year treatment?
A) It prevents the development of new cancers
B) It reduces the risk of relapse during the subsequent 15 years
C) It improves bone mineral density
D) It reduces the risk of cardiovascular events

Answer 21

Answer: B) It reduces the risk of relapse during the subsequent 15 years
Rationale: Extended adjuvant endocrine therapy with either tamoxifen or an AI for an additional 5 years continues to reduce the risk of distant recurrence and relapse, particularly in the years following the initial 5-year treatment period.

Question 22

What is the optimal number of chemotherapy cycles in the adjuvant setting?
A) 1–2 cycles
B) 3–4 cycles
C) 4–6 cycles
D) More than 6 cycles

Answer 22

Answer: C) 4–6 cycles
Rationale: Four to six cycles of chemotherapy provide optimal efficacy, with more than six cycles increasing toxicity without further improvement in outcomes.

Question 23

What is the preferred scheduling of paclitaxel in adjuvant chemotherapy?
A) Every 3 weeks
B) Weekly or every other week
C) Monthly
D) Every 6 weeks

Answer 23

Answer: B) Weekly or every other week
Rationale: Evidence supports dose-dense administration of paclitaxel (weekly or every-other-week) as superior to every-3-week dosing in terms of efficacy.

Question 24

Which toxicity is most commonly associated with taxane-based chemotherapy? A) Neutropenia B) Congestive heart failure C) Peripheral neuropathy D) Myelodysplasia

Answer 24

Answer: C) Peripheral neuropathy Rationale: Peripheral neuropathy is the major dose-limiting and life-changing toxicity of taxanes, affecting ~15–20% of patients during treatment, with 3–5% experiencing chronic neuropathy.

Question 25

What is “chemo-brain,” and how is it typically characterized? A) Irreversible cognitive decline due to direct chemotherapeutic effects B) Temporary cognitive dysfunction caused by chemotherapy or related factors C) Depression and anxiety unrelated to chemotherapy D) Memory impairment specific to anthracycline use

Answer 25

Answer: B) Temporary cognitive dysfunction caused by chemotherapy or related factors Rationale: “Chemo-brain” refers to cognitive dysfunction that may result from chemotherapy or related factors like anxiety, depression, or fatigue. It usually resolves a few months after treatment ends.

Question 26

What is the optimal duration of trastuzumab therapy for early-stage breast cancer? A) 6 months B) 9 months C) 12 months D) 18 months

Answer 26

Answer: C) 12 months Rationale: Twelve months of trastuzumab therapy is optimal, providing maximal benefit in reducing recurrence and mortality. Longer durations do not add additional benefit, and 6 months is less effective than 12 months.

Question 27

Why is concurrent administration of trastuzumab with an anthracycline generally avoided? A) It decreases the efficacy of trastuzumab B) It increases the risk of cardiac dysfunction C) It reduces the efficacy of anthracyclines D) It increases the risk of thrombocytopenia

Answer 27

Answer: B) It increases the risk of cardiac dysfunction Rationale: Trastuzumab’s main toxicity is cardiac dysfunction, which occurs more frequently when given concurrently with anthracyclines like doxorubicin.

Question 28

What is the recommended approach for patients who do not achieve a pathologic complete response (pCR) after neoadjuvant trastuzumab-based therapy? A) Continue trastuzumab for 12 months B) Switch to ado-trastuzumab emtansine C) Add lapatinib to trastuzumab D) Discontinue anti-HER2 therapy

Answer 28

Answer: B) Switch to ado-trastuzumab emtansine Rationale: Postoperative ado-trastuzumab emtansine is superior to trastuzumab in patients who do not achieve a pCR, providing better outcomes in reducing recurrence risk.

Question 29

What monitoring is required for patients receiving trastuzumab? A) Liver function tests B) Serial echocardiography C) Complete blood count D) Bone mineral density

Answer 29

Answer: B) Serial echocardiography Rationale: Trastuzumab can cause cardiac muscle dysfunction, so baseline and serial echocardiographic monitoring is essential, especially in patients with a history of cardiac abnormalities.

Question 30

What is the most appropriate imaging modality for new-onset back pain in a patient with breast cancer? A) X-ray B) CT scan C) Spine MRI D) Bone scan

Answer 30

Answer: C) Spine MRI Rationale: New back pain in breast cancer patients should be aggressively explored using spine MRI to rule out spinal metastases or impending cord compression. Delaying evaluation until neurological symptoms arise can result in catastrophic outcomes.

Question 31

What potential complication should be considered in a breast cancer patient with metastatic endocrine organ involvement? A) Hyperthyroidism B) Adrenal insufficiency C) Diabetes insipidus D) Hypoparathyroidism

Answer 31

Answer: B) Adrenal insufficiency Rationale: Metastatic involvement of endocrine organs can lead to profound dysfunction, including adrenal insufficiency, which requires prompt recognition and management.

Question 32

Which of the following patients is most likely to benefit from treatment with an aromatase inhibitor (AI)? A) A premenopausal woman with metastatic ER-positive breast cancer B) A postmenopausal woman who has never received an AI before C) A postmenopausal woman with a history of AI use who recently discontinued therapy D) A premenopausal woman receiving ovarian suppression therapy

Answer 32

Answer: B) A postmenopausal woman who has never received an AI before Rationale: AIs are most effective in postmenopausal women whose estrogen production comes mainly from adrenal precursors, as these are converted to estrogens by aromatase. AIs are not used in premenopausal women with functioning ovaries because estrogen deprivation leads to gonadotropin release and increased ovarian estrogen synthesis.

Question 33

Which of the following drugs is a selective estrogen receptor downregulator (SERD)? A) Tamoxifen B) Letrozole C) Fulvestrant D) Exemestane

Answer 33

Answer: C) Fulvestrant Rationale: Fulvestrant is a SERD, which works by downregulating and degrading estrogen receptors. Tamoxifen is a selective estrogen receptor modulator (SERM), and letrozole and exemestane are aromatase inhibitors (AIs).

Question 34

What is the role of CDK4/6 inhibitors in the treatment of ER-positive metastatic breast cancer? A) They are used as monotherapy for patients who fail endocrine therapy B) They enhance the efficacy of chemotherapy in combination regimens C) They improve progression-free survival when combined with endocrine therapy D) They are only effective in premenopausal women

Answer 34

Answer: C) They improve progression-free survival when combined with endocrine therapy Rationale: CDK4/6 inhibitors, such as palbociclib, ribociclib, and abemaciclib, significantly enhance progression-free survival in ER-positive metastatic breast cancer when combined with an AI or fulvestrant. They are not used as monotherapy or exclusively for premenopausal patients.

Question 35

What is a common side effect of everolimus, and how can it be managed? A) Neutropenia; managed by dose adjustments B) Diarrhea; managed with loperamide C) Fatigue; managed with rest and exercise D) Mucositis; managed with dexamethasone mouthwash

Answer 35

Answer: D) Mucositis; managed with dexamethasone mouthwash Rationale: Everolimus commonly causes mucositis, which can be prevented or treated using a dexamethasone-containing mouthwash. Diarrhea is also a side effect, but mucositis is more characteristic.

Question 36

Why are AIs not recommended for use in premenopausal women with functioning ovaries? A) They are ineffective in reducing estrogen levels in premenopausal women B) They can lead to ovarian suppression and menopause-like symptoms C) They cause a rebound increase in ovarian estrogen synthesis D) They are associated with higher rates of neutropenia in premenopausal women

Answer 36

Answer: C) They cause a rebound increase in ovarian estrogen synthesis Rationale: AIs block peripheral aromatase activity, which lowers estrogen levels. In premenopausal women, this triggers the hypothalamus to release gonadotropins, leading to increased ovarian estrogen production, counteracting the drug's effects.

Question 37

What is the most appropriate first-line therapy for ER-positive metastatic breast cancer in most patients? A) Aromatase inhibitor (AI) monotherapy B) Tamoxifen combined with chemotherapy C) CDK4/6 inhibitor combined with an AI or fulvestrant D) Everolimus combined with fulvestrant

Answer 37

Answer: C) CDK4/6 inhibitor combined with an AI or fulvestrant Rationale: Current guidelines recommend a CDK4/6 inhibitor (e.g., palbociclib, ribociclib, abemaciclib) in combination with either an AI or fulvestrant as the first-line therapy for ER-positive metastatic breast cancer. This combination significantly improves progression-free survival and overall outcomes.

Question 38

Which of the following antibody-drug conjugates is used after progression on trastuzumab therapy? A) Ado-trastuzumab emtansine B) Pertuzumab C) Margetuximab D) Lapatinib

Answer 38

Answer: A) Ado-trastuzumab emtansine Rationale: Ado-trastuzumab emtansine is an antibody-drug conjugate effective after progression on trastuzumab. Other agents, such as pertuzumab and margetuximab, are not classified as antibody-drug conjugates, and lapatinib is a tyrosine kinase inhibitor.

Question 39

Which tyrosine kinase inhibitor is more effective than lapatinib when combined with capecitabine in patients who have progressed on two or more prior anti-HER2 regimens? A) Neratinib B) Tucatinib C) Margetuximab D) Ado-trastuzumab emtansine

Answer 39

Answer: A) Neratinib Rationale: Neratinib, when added to capecitabine, has shown superior efficacy compared to lapatinib in patients who have received two or more prior anti-HER2 therapies. Tucatinib is effective in combination with trastuzumab and capecitabine in heavily pretreated patients, including those with brain metastases.

Question 40

What is the recommended treatment strategy for HER2-positive patients with brain metastases who have progressed on multiple therapies? A) Trastuzumab alone B) Tucatinib in combination with trastuzumab and capecitabine C) Neratinib monotherapy D) Pertuzumab combined with ado-trastuzumab emtansine

Answer 40

Answer: B) Tucatinib in combination with trastuzumab and capecitabine Rationale: Tucatinib combined with trastuzumab and capecitabine is particularly effective for HER2-positive breast cancer patients with brain metastases who have progressed on other therapies, improving both progression-free survival and overall survival.

Question 41

What is the primary benefit of bone-modifying agents for patients with bone metastases? A) Prevention of primary bone tumors B) Reduction in cancer-related skeletal events C) Cure of bone metastases D) Improvement in overall survival

Answer 41

Answer: B) Reduction in cancer-related skeletal events Rationale: Bone-modifying agents such as bisphosphonates and denosumab reduce cancer-related skeletal events, including fractures, bone pain, and hypercalcemia of malignancy. They are not curative and do not prevent primary bone tumors.

Question 42

Which complication is associated with both bisphosphonates and denosumab? A) Severe renal dysfunction B) Hypercalcemia of malignancy C) Osteonecrosis of the jaw D) Increased risk of bone metastases

Answer 42

Answer: C) Osteonecrosis of the jaw Rationale: Both bisphosphonates and denosumab are associated with the rare but serious complication of osteonecrosis of the jaw, particularly in patients receiving long-term treatment.

Question 43

What strategy has been shown to reduce the risk of osteonecrosis of the jaw in patients receiving bone-modifying agents? A) Monthly administration of the treatment B) Ensuring adequate dentition before treatment C) Combining bisphosphonates with chemotherapy D) Avoiding treatment in patients with bone pain

Answer 43

Answer: B) Ensuring adequate dentition before treatment Rationale: Adequate dental health before initiating bone-modifying agents and switching to a 3-month dosing schedule instead of monthly can help reduce the incidence of osteonecrosis of the jaw.

Question 44

What is the mechanism of action of denosumab? A) Inhibition of bone resorption by osteoclasts B) Direct cytotoxicity against cancer cells C) Stimulation of bone formation by osteoblasts D) Promotion of calcium reabsorption in the kidneys

Answer 44

Answer: A) Inhibition of bone resorption by osteoclasts Rationale: Denosumab is an anti-RANK antibody that inhibits osteoclast-mediated bone resorption, thereby reducing the risk of skeletal events in patients with bone metastases.

Question 45

Which statement about adjuvant chemotherapy in pregnancy is correct? A) Chemotherapy is safe in all trimesters of pregnancy. B) Adjuvant chemotherapy should be delayed until after delivery. C) Doxorubicin and cyclophosphamide can be safely given after the first trimester. D) Anti-HER2 therapies are safe during pregnancy.

Answer 45

Answer: C) Doxorubicin and cyclophosphamide can be safely given after the first trimester. Rationale: Certain chemotherapeutic agents, including doxorubicin and cyclophosphamide, are considered safe for use during the second and third trimesters, while anti-HER2 therapies should be avoided due to the risk of fetal malformations.

Question 46

Why should anti-HER2 antibody therapies be avoided during pregnancy? A) They are ineffective during pregnancy. B) They increase the risk of maternal complications. C) They result in unacceptable fetal malformations and complications. D) They interfere with embryogenesis.

Answer 46

Answer: C) They result in unacceptable fetal malformations and complications. Rationale: Anti-HER2 therapies have been associated with fetal malformations and pregnancy complications and are contraindicated during pregnancy.

Question 47

What is the general recommendation for endocrine therapy in pregnant patients with breast cancer? A) Administer endocrine therapy after the first trimester. B) Use endocrine therapy concurrently with chemotherapy. C) Delay endocrine therapy until after delivery. D) Endocrine therapy is contraindicated at all times in breast cancer.

Answer 47

Answer: C) Delay endocrine therapy until after delivery. Rationale: Endocrine therapies are postponed until after delivery because their safety during pregnancy is not established.

Question 48

Which therapy targets the loss of tumor suppressor activity of BRCA1/2? A) PARP inhibitors B) CDK4/6 inhibitors C) Tyrosine kinase inhibitors D) Antibody-drug conjugates

Answer 48

Answer: A) PARP inhibitors Rationale: Loss of BRCA1/2 activity results in defective DNA repair, and PARP inhibitors, such as olaparib and talazoparib, exploit this vulnerability.

Question 49

For immune checkpoint inhibition, which therapy is utilized in breast cancer? A) Trastuzumab B) Atezolizumab C) Lapatinib D) Fulvestrant

Answer 49

Answer: B) Atezolizumab Rationale: Atezolizumab is a PD-L1/PD-1 immune checkpoint inhibitor, enhancing immune effector cell activity against tumor cells.