Breast Care Nurse Certification
Susan, age 40, has a strong family history of breast cancer and is also positive for the BRCA1 gene. She is considering undergoing a bilateral oophorectomy to reduce her risk of breast cancer. Your most appropriate response to her would be
"A bilateral oophorectomy will reduce your risk of breast cancer by 50%."
You are providing a community education program on cancer prevention when a participant asks what cancer screening is and if it is important if you are healthy and have no problems. Your most appropriate response is
"Cancer screening is aimed at individuals with no symptoms with the goal of finding disease when it is more easily treated."
Your patient, Mrs. Smith, who has breast cancer and a BRCA1 mutation, asks you if her 35-year-old daughter should have risk-reduction surgery to prevent her from developing breast cancer. Your best advice to her is which one of the following?
"For your daughter to fully understand her risk, she should go through formal risk assessment and see a genetic health professional before she makes any decision."
Mary has a family history of breast cancer and would like to have genetic testing to learn if she is at high risk. However, she is concerned that her employer may find out if the results are positive, and that it would affect her employment and insurance. Your best response to Mary is
"GINA prohibits employers from using a person's genetic information to influence firing or promotion decisions; however, employers can collect genetic information for wellness programs."
Joan is considering taking hormonal replacement therapy (HRT) for her chronic osteoporosis. Which of one the following is the most appropriate response to her questions about HRT?
"HRT has been shown to reduce fractures related to osteoporosis, but can increase your risk of developing breast cancer."
Which one of the following statements by a participant in a community health fair demostrates understanding of some aspects of quality control of screening mammography facilities?
"I can find data about adverse events and actions taken against mammography facilities in my area."
A student nurse under your supervision is about to perform her first breast examination on a patient with known pathology. You know she is using proper technique when she tells you
"I should palpate the normal breast first."
A female patient, age 50, who is postmenopausal, tells you that she has recently experienced nipple discharge that is bilateral and milky. Your most appropriate response to her would be
"Nipple discharge is normal most of the time when it is bilateral. You should be examined if it becomes a persistent problem."
On Jane's follow-up visit to the breast health center after a diagnostic mammogram that reveals a suspicious mass, the surgeon tells her that he wants her to meet the patient navigator. The surgeon's best explanation of the reason for the referral is
"The navigator will help you schedule some additional tests and help with transportation and childcare if needed."
A 35 year old woman who is breastfeeding comes to the clinic seeking prescription for a mammogram. She is experiencing fever, a breast lump, unilateral breast pain, redness, and tenderness of the affected breast. The most appropriate response to her is:
"We will do a breast examination on you today to see if you have a breast asbcess."
What percentage of breast cancers occur in males in the United States?
1%
Approximately what percentage of people with breast cancer have an increased risk for cancer due to a hereditary predisposition?
5%-10%
What percentage of cases of breast cancer occur in women older than 50?
75%
Survival rates from cancer continue to improve. Which one of the following most accurately depicts the percentage of breast cancer patients surviving 5 years and beyond after diagnosis?
90% beyond 5 years
Eric is a member of a research team that conducts an epidemiologic study. The team determines that in a given year, approximately 1 out of every 8 American women has breast cancer. This figure represents
A prevalence rate
The Breast Cancer Risk Assessment Tool is used to estimate which one of the following?
A woman's risk of developing breast cancer in the next 5 years and up to age 90
Which one of the following racial groups of American women have the highest rate of death from breast cancer?
African American women
Demographic trends show that the number of overall cancer survivors continues to increase due to
Aging population and improvement in cancer detection and treatment
Once the elements of a cancer risk assessment are collected (e.g., personal medical history, history of exposures to carcinogens, family history), the risk must be interpreted to the individual in understandable terms. This is often accomplished by using various risk terms. Which one of the following terms is accurate?
Attributable risk is the amount of disease within the population that could be prevented by alteration of a risk factor.
Genetic risk factors for the development of breast cancer that warrant further evaluation include which of the following?
BRCA1/BRCA2 and PTEN gene mutation
According to the National Comprehensive Cancer Network, when should women who have a prior history of thoracic radiation therapy (RT) and are 25 years of age or older begin annual mammograms plus clinical breast exams every 6 or 12 months as part of their breast cancer screening?
Begin 3 to 5 years after RT or age 25, whichever is more recent
Which one of the following risk factors is associated with inflammatory breast cancer?
Black women older than 50 years
The most widely used screening programs have been for the early detection of
Breast and cervical cancer
MJ is 28 and had a palpable breast mass that resolved after observing it for 1 to 2 menstrual cycles. What would you instruct her about regarding appropriate breast cancer screening?
Breast avwareness and report any healthcare changes
Moderate to heavy alcohol use has been linked to which of the following cancers?
Breast, colorectal, and esophageal
Most chemopreventive agents are administered through a clinical trial. Which one of the following individuals most likely would be considered for a chemoprevention trial?
C. A 40-year-old female whose mother died of breast cancer
The Breast Imaging Reporting and Data System (BI-RADS®) is used to summarize findings on mammograms. Which BI-RADS® category is used to indicate a benign finding with routine follow-up recommended?
Category 2
The Gail model, a breast cancer risk assessment tool, has been validated for what population of women?
Caucasian women
Mrs. Henderson's cancer is said to have been induced by familial carcinogenesis. From this, you can assume that in her case certain genes
Caused cancer by their absence
Mrs. Rodriguez's cancer is said to have been induced by familial carcinogenesis. From this, you can assume that in her case certain genes
Caused cancer by their absence
Chemoprevention focuses on individuals or subpopulations known to be at increased risk for developing a malignancy. Which one of the following best describes chemoprevention?
Chemoprevention is the use of natural or synthetic agents to interrupt the carcinogenic process.
Physical activity is one of the few known modifiable lifestyle factors, and increased exercise plays a key role in primary prevention against which of the following cancers?
Colon, breast, and endometrial
Epidemiology studies have provided compelling evidence that obesity is associated with increased risks of
Colon, endometrial, and postmenopausal breast cancer
Multiple barriers to breast cancer care have been identified. The navigator can assist patients in overcoming these barriers by doing which one of the following?
Completing an assessment of the resources and needs of the individual patient
The prognosis of pregnant women with breast cancer when matched for age and stage of the disease
Does not differ from that of nonpregnant women with breast cancer
Ms. Jones recently read a report from the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) that made recommendations to decrease cancer risk. She has decided to modify her lifestyle and follow their recommendations. Which one of the following is a recommendation by the WCRF/AICR?
Eat a healthy diet and be physically active for at least 30 minutes/day.
A 48-year-old woman had a routine e. screening mammogram that revealed a spiculated mass on the upper outer opent quadrant of the left breast measuring 1.3 cm. She was scheduled to return for additional imaging and referred to the breast health navigator. The most important information to give the woman when calling on the telephone is
Education about the purpose and importance of additional imaging
A patient is found to have atypical lobular hyperplasia (ALH) after a core-needle biopsy Based on the relative risk of ALH developing into a future breast cancer, you would expect the next recommended procedure for this patient to be
Excisional biopsy
A primary risk factor for breast cancer is
Family history of breast cancer
Fibroadenomas, common benign breast tumors, are best diagnosed by which one of the following?
Fine-needle aspiration
A nurse asks you which risk model should be a cancer susceptibility mutation for breast used to calculate a patient's risk of having cancer. What one of the following is correct?
Ford model
Which one of the following breast cancer risk models includes a risk assessment item for male breast cancer?
Ford model
Which one of the following breast cancer risk assessment tool(s) evaluate breast cancer gene mutation carriers?
Ford model and BRCAPRO tools
What is the most identifiable risk factor for the subsequent development of breast cancer?
Forty-year-old female with lobular carcinoma in situ (LCIS)
Which one of the following cancer-causing mutations is transmitted to the next generation at birth?
Germ cell mutations
After her mother's death from breast cancer, Ella takes the initiative in preventing breast cancer for herself by eating less fat and more fruits and vegetables and by increasing her exercise. She is engaged in
Health-protective behavior
Which one of the following is an appropriate recommendation for breast MRI screening as an adjunct to mammography?
In a woman with a BRCA gene mutation
Measuring the success of breast care navigation can be challenging. The most useful metric to measure success is
Increasing the number and percentage of women having screening mammography from the defined targeted geographic region
The best description of lay navigators is
Individuals in the community that help patients navigate the healthcare system and identify barriers to care and resources
Which one of the following is an unfavorable histological type of invasive breast cancer?
Infiltrating lobular carcinoma
Which one of the following represents the strongest risk factor in the development of breast cancer in males?
Klinefelter syndrome
Characteristics most likely to be associated with lobular carcinoma in situ (LCIS) include which one of the following?
LCIS will not turn into a cancer but is a premalignant change that represents high risk for breast cancer development
Which one of the following is considered a precancerous condition?
Lobular carcinoma in situ
Josie comes to the clinic with a chief complaint of persistent unilateral clear niple discharge that is reproducible on breast exam. According to National Comprehensive Cancer Network, what is the most appropriate measure with this complaint?
Mammogram +/- ultrasound
Alexis, age 27 years, brings her mother Margie, 48, in for a clinical breast exam. Both women have avoided regular medical care because they fear the discovery of problems. During the course of the interview, you discover that neither is familiar with screening for breast cancer. Which one of the following recommendations should be part of your patient education plan?
Margie should begin getting a mammogram annually; Alexis can wait until she is age 45.
Tenderness, breast pain, and sensations of tightness in one or both breasts that commonly occurs in women is referred to as
Mastodynia
As a newly hired breast care navigator, your supervisor wants you to conduct a needs assessment. Your best source of statistics about screening mammography in the population you are striving to serve is
Medicare and Medicaid data regarding the rate of compliance with annual screening mammography and demographic data such as geographic, economic status, and age groups
Which one of the following is a characteristic of breast cancer in males?
Men are found to be significantly older at diagnosis than women.
Which one of the following is the most appropriate response to a patient regarding established breast cancer risk factors?
Menarche starting before the age of 12 is a breast cancer risk factor.
Which one of the following statements regarding the incidence of breast cancer is true?
More than 50% of breast cancer occurs in women who are 61 years of age or older.
Which one of the following statements about patient navigation is most accurate?
Navigators provide individualized care to assist patients as they transition through the healthcare system.
The highest breast cancer incidence rates in the United States are found in:
Non-Hispanic white women
The Claus model for breast cancer risk assesses
Number of first- and second-degree relatives with breast cancer
Which one of the following statements regarding breast cancer risk is accurate?
Only 5%-10% of all breast cancers are due to tumor-suppressor genes BRCA1 and BRCA2.
You educate Miss Chan about the prevention of breast cancer and risk-reducing behaviors. Which one of the following is a primary preventive strategy?
Prophylactic mastectomy in high-risk women
Harold Freeman, a pioneer in patient mnavigation, identified health disparities for which one of the following groups?
Racial/ethnic minorities, those with low socioeconomic status, and rural populations
Which one of the following has been associated with an increased incidence of breast cancer in women?
Radiation to the chest
The single most important factor in whether an individual has ever had a screening test is
Recommendation by a nurse
with which of the following symptoms Paget's disease of the nipple often presents with what symptoms?
Redness, mild scaling, and flaking of the affected nipple
Which statement is the best reason to recommend risk-reduction bilateral mastectomy for a woman with high genetic risk of breast cancer?
Removal of the breasts before cancer detection lowers risk by 90%.
A colleague asks you what knowledge she would require to be a breast cancer navigator. Your reply is
Screening, detection, diagnosis, and treatment of breast cancer
Which one of the following is the best description of simple breast cysts?
Smooth, rounded lumps that are moveable within the breast
The Breast Cancer Prevention Trial tested the ability of which one of the following to prevent breast cancer in healthy women at high risk for the disease?
Tamoxifen
Which one of the following statements regarding genetic predisposition to cancer is correct?
The BRCA1/BRCA2 gene mutations are associated with increased susceptibility to breast cancer and ovarian cancer.
Which one of the following statements regarding our understanding of the genetic susceptibility in breast cancer and ovarian cancer is correct?
The BRCA2 gene mutation is associated with an increased susceptibility to both breast and ovarian cancer.
Which one of the following statements regarding the BRCA2 gene mutation is true?
The BRCA2 gene mutation is related to breast cancer in men.
What regulatory act or agency serves to regulate quality control for mammography in the United States?
The Mammography Quality Standards Act (MQSA)
Which one of the following statements is most accurate regarding the cancer screening process?
The first step in the cancer screening process is the risk assessment.
Ductal carcinoma in situ (DCIS) is
The most common premalignant breast condition
Genes that predispose for the development of cancer are generally transmitted in an autosomal dominant fashion. Which one of the following statements is correct?
The pattern of transmission is usually vertical, meaning successive generations are affected.
Which one of the following statements about breast cancer in lesbians is correct?
The risk of breast cancer in lesbian women is increased as compared to heterosexual women.
Nurses must communicate to patients about the accuracy of screning tests. Which one of the following attributes is correct?
The specificity of a screening test is its ability to identify those individuals without cancer.
Research has shown that providing patients with an individualized risk estimate significantly increased the probability that those individuals would participate in a screening program. It is best to explain to patients which one of the following?
Their absolute and relative risk of developing cancer
The breast nurse navigator can identify opportunities to decrease patient anxiety and influence system efficiency by documenting which one of the following?
Time from biopsy to surgical or medical intervention
The primary purpose of patient navigator programs is
To provide personal assistance in eliminating any barriers to patients obtaining timely and adequate diagnosis and treatment
The purpose of screening mammograms is
To provide routine breast surveillance for the asymptomatic patient
Which one of the following lifestyle factors is the most important risk factor for the development of breast cancer?
Use of exogenous hormones
The most important risk-reduction behavior for the prevention of breast cancer is
Weight management
Which one of the following scenarios represents secondary prevention of breast cancer?
Women are referred for mammograms.
The first patient navigators working at Harlem Hospital focused on which of the following patients?
Women from the community and those attending breast health centers
You are participating in a community health fair for senior citizens. What is the most appropriate response regarding mammographic screening in women over the age of 65?
Women over the age of 65 who are otherwise healthy and would choose to treat breast cancer if it were found should have annual mammograms.
Which statement about atypical ductal hyperplasia (ADH) is correct?
Women with ADH have a 4-fold increased risk of breast cancer development.
The Gail model and the Breast Cancer Risk Assessment Tool (developed by the National Cancer Institute) capture which one of the following potential risks for breast cancer?
Women with risk of developing breast cancer in the next 5 years
During follow-up counseling for your 47-year-old patient with hereditary breast cancer, you mention that she should consider genetic counseling even though her cancer is not due to BRCA1 or BRCA2. To up clear her confusion, you explain which one of the following?
Women younger than age 50 with hereditary breast cancer have a significant risk of developing contralateral breast cancer in the next 20 years.
The most common physical finding related to breast cancer is
a. A nontender hard mass
breast health of African following statements best describes the According to research, which one of the American women of lower socioeconomic status (SES) compared to age-adjusted Caucasian women?
a. Breast cancer outcomes in minority women with a lower SES are worse than those of women with a higher SES.
Which one of the following statements best describes the significance of the BRCA1 gene?
b. It is an inherited gene mutation that identifies families at significant risk for breast cancer and ovarian cancer.
You are teaching breast self-examination (BSE) to high school girls at a high school health fair. Which one of the following statements by a participant demonstrates that she understands an important principle in BSE?
c. "It is appropriate to do BSE a few days after my menstrual cycle ends."
A patient asks, "What are tumor-suppressor genes?" As part of your answer, you explain that tumor-suppressor genes code for proteins that _______ growth-promoting factors.
c. Inactivate
Which one of the following statements regarding our understanding of the genetic susceptibility in breast cancer and ovarian cancer is correct?
mutation is associated The BRCA2 gene with an increased susceptibility to both breast and ovarian cancer.