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begin annual routine screening at age 30 (but not before age 25) or 10 years earlier than the age of their relatives’ diagnosis, whichever is later. In this case, if the patient was not a BRCA2 mutation carrier she would have begun screening at age 35 based on her mother’s history and at age 32 based on her sister’s history. Forty is the age when women who do not have an increased risk of breast cancer to begin screening.
Reference: Lee CH, Dershaw DD, Kopans D, et al. Breast cancer screening with imaging: Recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010;7:18–27.
7   Answer A.
B.  MRI is recommended in women with >20% lifetime risk for breast cancer on the basis of family history.
C.  Women with a history of chest irradiation should begin screening MRI 8 years after the completion of radiation therapy, not necessary at age 30.
D.  Women with a history of biopsy-proven ADH should be considered for screening MRI only if other factors make their overall lifetime risk between 15% and 20%.
Reference: Lee CH, Dershaw D, Kopans D, et al. Breast cancer screening with imaging: Recommendations from the society of breast imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010;7:18–27.
8   Answer E. The positive predictive value (PPV) of biopsy will be increased because of a substantial reduction in the number of interventional procedures that produce benign results.
A.  Periodic mammographic surveillance does not affect call-back rates.
B.  Operating costs will decrease substantially because (1) the cost of diagnostic examinations usually is much lower than that of imaging-guided interventional procedures and (2) surveillance adds cost only to the extent that it requires examinations in between those performed for routine screening, which for most follow-up protocols involves only one additional examination.
C.  False-positive results will be reduced, similar to increase in PPV, due to reduction of the number of interventions that produce benign results.
D.  Surveillance is associated with reduced morbidity, especially when compared to open surgical biopsy but also when compared to percutaneous imaging-guided tissue sampling.
Reference: Sickles EA. Probably benign breast lesions: when should follow-up be recommended and what is the optimal follow-up protocol? Radiology 1999;213:11–14.
9   Answer A. According to BI-RADS manual, lesions appropriately placed in BI-RADS category 3 include a nonpalpable, circumscribed mass on a baseline mammogram (unless it can be shown to be a cyst, an intramammary lymph node, or another benign finding), a focal asymmetry that partially thins on spot compression, and a cluster of round punctate calcifications. Answer choices B, D, and E should be given a BI-RADS 0 category assessment and be called back for additional imaging, and if persist, undergo biopsy. Answer choice C is a benign lesion.
Reference: American College of Radiology (ACR). BI-RADS Mammography: Guidance Chapter .
Reston, VA: American College of Radiology; 2012:254–255.
10   Answer B. Computer-aided detection (CAD) mammography increases breast cancer detection rate ~7% to 20%.
A.  CAD sensitivity is greater for calcifications than masses.
C.  Use of CAD increases the recall rate by about 8.2%.
D.  CAD is to provide “spell check” while looking at screening mammograms, after independent or unaided case assessment by radiologist. It is not a primary tool in reading mammograms.
E.  CAD makes about 2.0 false marks per every four-view negative mammogram. However, with experience, overwhelming majority of false CAD marks are readily dismissed.
Reference: Birdwell RL, Bandodkar P, Ikeda DM. Computer-aided detection