| Question 1: For women who are premenopausal or around the age of menopause the replacement of film mammography by digital mammography resulted in: |
| Reference: | Pisano, E.D., Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, Conant EF, Fajardo LL, Bassett L, D'Orsi C, Jong R, Rebner M. Diagnostic accuracy of digital versus film mammography for breast cancer screening - The results of the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST). NEJM, 353, 1773-1783, 2005. |
| Choice A: | Improved specificity of cancer detection |
| Choice B: | Better sensitivity |
| Choice C: | Increased radiation dose |
| Choice D: | Greater compression of the breast |
| Question 2: Overdetection refers to: |
| Reference: | Yaffe MJ, Pritchard KI. Commentary: Overdiagnosing Overdiagnosis, The Oncologist 2014 19(2) 103-106. |
| Choice A: | Finding lobular cancers |
| Choice B: | Finding too many Stage 2 cancers |
| Choice C: | False positive mammograms |
| Choice D: | Finding cancer that doesn’t need to be detected |
| Question 3: Use of quality adjusted life-years as an outcome measure for screening shifts the age distribution of benefit downward. |
| Reference: | Yaffe MJ, Mittmann N, Alagoz O, Trentham-Dietz A, Tosteson ANA, Stout NK. The effect of mammography screening on incidence-based breast cancer mortality. J Med Screen. 2018 Dec;25(4):197-204. doi: 10.1177/0969141318780152.
Tsuchiya A. QALYs and ageism: philosophical theories and age weighting. Health Econ. 2000 Jan;9(1):57-68. |
| Choice A: | True |
| Choice B: | False |
| Question 4: The sensitivity of breast MRI is higher than mammography for screening. |
| Reference: | Warner E, Plewes DB, Hill K, Causer P, Wong J, Jong RA, Cutrara M, DeBoer G, Ramsay E, Yaffe MJ, Messner S, Meschino W, Piron C, Narod S. Comparison of Magnetic Resonance Imaging (MRI), ultrasound (US), mammography (M), and Clinical Breast Examination (CBE) for breast cancer surveillance for women at high risk for hereditary breast cancer. NYU 'The Emerging Role of Screening & Prevention in Women's Cancers.
Kuhl CK, Schrading S, Strobel K, et al. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection — a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014 Aug 1;32(22): 2304–10. |
| Choice A: | True |
| Choice B: | False |
| Question 5: The strengths of screening digital breast tomosynthesis (DBT) compared to full-field digital mammography (FFDM) include: |
| Reference: | Sharpe RE, Jr., Venkataraman S, Phillips J, et al. Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program. Radiology 2016;280:981. |
| Choice A: | Increased recall rate |
| Choice B: | Decreased radiation dose |
| Choice C: | Reduction in false positive recalls |
| Choice D: | Decreased time in compression |
| Question 6: Studies have shown that synthetic mammography (SM)/DBT demonstrates: |
| Reference: | Gilbert FJ, Tucker L, Gillan MG, et al. Accuracy of Digital Breast Tomosynthesis for Depicting Breast Cancer Subgroups in a UK Retrospective Reading Study (TOMMY Trial). Radiology 2015;277:697-706. |
| Choice A: | Longer acquisition time compared to FFDM/DBT |
| Choice B: | Comparable sensitivity and specificity for the detection of cancer compared to FFDM/DBT |
| Choice C: | Decreased specificity in the detection of cancer compared to FFDM/DBT |
| Choice D: | Less pseudocalcifications compared to FFDM/DBT |
| Question 7: Artifacts more commonly encountered in synthetic mammography (SM) compared to full-field digital mammography (FFDM) include: |
| Reference: | Ratanaprasatporn L, Chikarmane SA, Giess CS. Strengths and Weaknesses of Synthetic Mammography in Screening. Radiographics 2017;37:1913-27. |
| Choice A: | Increased skin resolution |
| Choice B: | Decreased subcutaneous blurring |
| Choice C: | Pseudocalcifications |
| Choice D: | Increased axillary contrast resolution |
| Question 8: The PPV3 of contrast enhanced digital mammography (CEDM) is ______ MRI. |
| Reference: | Jochelson MS, Pinker K, Dershaw DD, et al. Comparison of screening CEDM and MRI for women at increased risk for breast cancer: A pilot study. Eur J Radiol 2017;97:37-43. |
| Choice A: | Greater than |
| Choice B: | Similar to |
| Choice C: | Less than |
| Question 9: Which of the following is true regarding digital breast tomosynthesis (DBT)-guided vacuum assisted biopsy (VAB)? |
| Reference: | Schrading S, Distelmaier M, Dirrichs T, et al. Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy. Radiology 2015;274:654-62. |
| Choice A: | A smaller field of view is utilized compared to stereotactic guided biopsy |
| Choice B: | It provides immediate lesion depth information without triangulation |
| Choice C: | Low contrast targets cannot be visualized or sampled |
| Choice D: | Calcifications cannot be sampled under DBT guidance |
| Question 10: What percentage of invasive breast cancers are detected between annual screening mammograms (i.e., interval cancers)? |
| Reference: | van Bommel RMG, Weber R, Voogd AC, et al. Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography (2017) BMC Cancer, 17(315).
Bennett RL, Sellars SJ, and Moss SM. Interval cancers in the NHS breast cancer screening programme in England, Wales and northern Ireland (2011) Br J Cancer, 104(4):571-577. |
| Choice A: | 0.2% |
| Choice B: | 12% |
| Choice C: | 40% |
| Choice D: | 80% |
