CBCN Certified breast care nurse
credential validating expertise in breast
disease management, screening,
education, and support.
Question 1
A 52-year-old female undergoes screening mammography. The report states BI-
RADS category 3 ("probably benign"). What is the appropriate next step?
A) Immediate biopsy
B) Short-interval follow-up mammography in 6 months
C) Routine annual screening
D) Surgical consultation
Rationale: BI-RADS category 3 ("probably benign") indicates a less than 2%
chance of malignancy and warrants short-interval follow-up imaging (typically 6
months) rather than immediate biopsy. Category 4 or 5 would require biopsy, and
category 1 or 2 would indicate routine screening.
Question 2
Male patients with breast cancer demonstrate a higher risk of exhibiting which
genetic mutation?
A) PALB2
B) MEN1
C) BRCA2
D) MLH1
Rationale: Male patients with breast cancer are more likely to have a BRCA2
mutation. BRCA2 mutations confer a higher lifetime risk of breast cancer in men
compared to BRCA1 mutations. MLH1 is associated with Lynch syndrome, MEN1
with multiple endocrine neoplasia, and PALB2 is a more recently identified breast
cancer susceptibility gene.
,Question 3
A patient with a first-degree relative diagnosed with breast cancer at age 40 should
be considered for which risk assessment?
A) Routine screening only
B) Genetic counseling and consideration of BRCA1/BRCA2 testing
C) Prophylactic mastectomy
D) Annual MRI only
Rationale: A first-degree relative with breast cancer diagnosed at age ≤50 is a red
flag for hereditary breast and ovarian cancer syndrome. Genetic counseling should
be offered to assess for BRCA1/BRCA2 mutations. Prophylactic surgery and MRI
are interventions that may follow genetic counseling but are not the initial step.
Question 4
Skin dimpling and retractions are accentuated with which of the following
positions?
A) Pectoral muscle contraction
B) Arms raised straight up to ears
C) Arms behind the back
D) Supine
Rationale: When a patient flexes the pectoral muscles by placing the hands on the
hips and pressing down, any skin dimpling or retractions become visible. This
position accentuates tethering of the skin to underlying tumor due to Cooper's
ligament involvement.
Question 5
According to the American Cancer Society, at what age should women at average
risk begin annual screening mammography?
A) Age 40
B) Age 45
C) Age 50
D) Age 55
,Rationale: The American Cancer Society recommends that women at average risk
have the option to begin annual mammography at age 40. The USPSTF
recommends biennial screening starting at age 50, but the ACS and other
organizations support earlier initiation.
Question 6
A 48-year-old woman with dense breast tissue on mammography is concerned
about missed cancers. Which supplemental screening modality is most
appropriate?
A) Breast ultrasound or MRI
B) PET scan
C) Thermography
D) Clinical breast exam only
Rationale: Dense breast tissue reduces mammographic sensitivity. Supplemental
screening with ultrasound or MRI can improve cancer detection in women with
dense breasts. Thermography is not an evidence-based screening modality, and
PET is not used for screening.
Question 7
A patient with a BRCA1 mutation is at increased risk for which of the following
cancers in addition to breast cancer?
A) Colon cancer
B) Ovarian cancer
C) Pancreatic cancer
D) Endometrial cancer
Rationale: BRCA1 mutations confer high risk for breast and ovarian cancers,
defining the hereditary breast-ovarian cancer syndrome. BRCA2 mutations also
increase risk for breast, ovarian, pancreatic, and prostate cancers, but BRCA1 is
most strongly associated with ovarian cancer.
, Question 8
A 35-year-old woman with a strong family history of breast cancer asks about the
Gail Model. The nurse should explain that this risk assessment tool estimates:
A) Lifetime risk of ovarian cancer
B) 5-year and lifetime risk of invasive breast cancer
C) Risk of BRCA mutation
D) Risk of contralateral breast cancer
Rationale: The Gail Model estimates a woman's 5-year and lifetime risk of
developing invasive breast cancer based on age, age at menarche, age at first live
birth, number of prior breast biopsies, and family history of breast cancer in first-
degree relatives. It does not assess ovarian cancer risk, BRCA status, or
contralateral risk.
Question 9
Which finding on clinical breast examination is most concerning for malignancy?
A) Mobile, rubbery, well-circumscribed mass
B) Tender, mobile mass that changes with menses
C) Fixed, hard, irregular mass with skin changes
D) Smooth, round, mobile mass
Rationale: A fixed, hard, irregular mass with skin changes (dimpling, erythema,
peau d'orange) is highly suspicious for malignancy. Benign lesions are typically
mobile, smooth, well-circumscribed, and may be tender with hormonal changes.
Question 10
What is the recommended screening modality for a woman with a known BRCA1
mutation?
A) Mammography alone
B) Annual mammography and annual breast MRI starting at age 25-30
C) Clinical breast exam only
D) Ultrasonography only
Rationale: High-risk women (including BRCA mutation carriers) should undergo
annual mammography and annual breast MRI starting at age 25-30. The
credential validating expertise in breast
disease management, screening,
education, and support.
Question 1
A 52-year-old female undergoes screening mammography. The report states BI-
RADS category 3 ("probably benign"). What is the appropriate next step?
A) Immediate biopsy
B) Short-interval follow-up mammography in 6 months
C) Routine annual screening
D) Surgical consultation
Rationale: BI-RADS category 3 ("probably benign") indicates a less than 2%
chance of malignancy and warrants short-interval follow-up imaging (typically 6
months) rather than immediate biopsy. Category 4 or 5 would require biopsy, and
category 1 or 2 would indicate routine screening.
Question 2
Male patients with breast cancer demonstrate a higher risk of exhibiting which
genetic mutation?
A) PALB2
B) MEN1
C) BRCA2
D) MLH1
Rationale: Male patients with breast cancer are more likely to have a BRCA2
mutation. BRCA2 mutations confer a higher lifetime risk of breast cancer in men
compared to BRCA1 mutations. MLH1 is associated with Lynch syndrome, MEN1
with multiple endocrine neoplasia, and PALB2 is a more recently identified breast
cancer susceptibility gene.
,Question 3
A patient with a first-degree relative diagnosed with breast cancer at age 40 should
be considered for which risk assessment?
A) Routine screening only
B) Genetic counseling and consideration of BRCA1/BRCA2 testing
C) Prophylactic mastectomy
D) Annual MRI only
Rationale: A first-degree relative with breast cancer diagnosed at age ≤50 is a red
flag for hereditary breast and ovarian cancer syndrome. Genetic counseling should
be offered to assess for BRCA1/BRCA2 mutations. Prophylactic surgery and MRI
are interventions that may follow genetic counseling but are not the initial step.
Question 4
Skin dimpling and retractions are accentuated with which of the following
positions?
A) Pectoral muscle contraction
B) Arms raised straight up to ears
C) Arms behind the back
D) Supine
Rationale: When a patient flexes the pectoral muscles by placing the hands on the
hips and pressing down, any skin dimpling or retractions become visible. This
position accentuates tethering of the skin to underlying tumor due to Cooper's
ligament involvement.
Question 5
According to the American Cancer Society, at what age should women at average
risk begin annual screening mammography?
A) Age 40
B) Age 45
C) Age 50
D) Age 55
,Rationale: The American Cancer Society recommends that women at average risk
have the option to begin annual mammography at age 40. The USPSTF
recommends biennial screening starting at age 50, but the ACS and other
organizations support earlier initiation.
Question 6
A 48-year-old woman with dense breast tissue on mammography is concerned
about missed cancers. Which supplemental screening modality is most
appropriate?
A) Breast ultrasound or MRI
B) PET scan
C) Thermography
D) Clinical breast exam only
Rationale: Dense breast tissue reduces mammographic sensitivity. Supplemental
screening with ultrasound or MRI can improve cancer detection in women with
dense breasts. Thermography is not an evidence-based screening modality, and
PET is not used for screening.
Question 7
A patient with a BRCA1 mutation is at increased risk for which of the following
cancers in addition to breast cancer?
A) Colon cancer
B) Ovarian cancer
C) Pancreatic cancer
D) Endometrial cancer
Rationale: BRCA1 mutations confer high risk for breast and ovarian cancers,
defining the hereditary breast-ovarian cancer syndrome. BRCA2 mutations also
increase risk for breast, ovarian, pancreatic, and prostate cancers, but BRCA1 is
most strongly associated with ovarian cancer.
, Question 8
A 35-year-old woman with a strong family history of breast cancer asks about the
Gail Model. The nurse should explain that this risk assessment tool estimates:
A) Lifetime risk of ovarian cancer
B) 5-year and lifetime risk of invasive breast cancer
C) Risk of BRCA mutation
D) Risk of contralateral breast cancer
Rationale: The Gail Model estimates a woman's 5-year and lifetime risk of
developing invasive breast cancer based on age, age at menarche, age at first live
birth, number of prior breast biopsies, and family history of breast cancer in first-
degree relatives. It does not assess ovarian cancer risk, BRCA status, or
contralateral risk.
Question 9
Which finding on clinical breast examination is most concerning for malignancy?
A) Mobile, rubbery, well-circumscribed mass
B) Tender, mobile mass that changes with menses
C) Fixed, hard, irregular mass with skin changes
D) Smooth, round, mobile mass
Rationale: A fixed, hard, irregular mass with skin changes (dimpling, erythema,
peau d'orange) is highly suspicious for malignancy. Benign lesions are typically
mobile, smooth, well-circumscribed, and may be tender with hormonal changes.
Question 10
What is the recommended screening modality for a woman with a known BRCA1
mutation?
A) Mammography alone
B) Annual mammography and annual breast MRI starting at age 25-30
C) Clinical breast exam only
D) Ultrasonography only
Rationale: High-risk women (including BRCA mutation carriers) should undergo
annual mammography and annual breast MRI starting at age 25-30. The
