For health professionals. This section uses clinical terms and is general education for doctors, nurses and students, not advice for an individual patient. Patients and families: please read our patient guides instead, Cancer Myth Busters · Understanding your cancer report · Living through cancer treatment, or speak with your own doctor.
60 clinical-vignette questions in three levels: 25 basics, 19 applied and innovative, and 16 challenging (32 Diagnosis, 4 Survivorship, 24 Treatment; 5 built on schematic X-ray, CT, mammogram or histology drawings). Practise question by question with instant marking, or take a timed mock test with a result summary by topic, level and section. You can also print the page as a booklet.
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Timed mock test. Random questions, about 80 seconds each (30 questions in 40 minutes). Answers stay hidden until you submit or time runs out; then you get a score by topic, level and section.
Level 1 · Basics
Core facts for NEET-PG and USMLE Step 1–2: histology, risk factors, presentation, staging and first-line principles.
Q1DiagnosisLevel 1Presentation, traps & genetics
A 32-year-old woman's mother had ovarian cancer at 46 and her maternal aunt breast cancer at 39. She asks which single gene most likely explains this family pattern.
ACDH1
BBRCA1
CTP53
DCHEK2
EPTEN
Show answer
Answer: B. Early-onset breast plus ovarian cancer on the same side of the family is the classic BRCA1/2 pattern; BRCA1 carries the higher ovarian risk. CHEK2 is a moderate-risk breast gene, PTEN (Cowden) adds thyroid and endometrial cancer, CDH1 links lobular breast with diffuse gastric cancer, and TP53 causes very early breast cancer with sarcomas and brain tumours.
A 61-year-old man has a hard, painless retroareolar lump with nipple retraction. Which statement is correct?
AHe should be offered germline genetic testing if cancer is confirmed
BMale breast cancer is usually HER2-positive
CGynaecomastia is the likely diagnosis; reassure
DSentinel-node biopsy is contraindicated in men
EAromatase inhibitor alone is the preferred adjuvant endocrine therapy
Show answer
Answer: A. An eccentric or hard, fixed, nipple-involving mass needs triple assessment. Every man with breast cancer should be offered germline testing (BRCA2 above all). Most male cancers are ER-positive; tamoxifen is preferred, and an AI is used only with a GnRH agonist. Sentinel-node biopsy is used as in women.
Which statement about breast cancer in Indian women is most accurate?
AMedian age at diagnosis is similar to Western women
BA higher proportion of tumours are triple-negative than in Western series
COrganised mammography screening covers most women aged 50–69
DMale breast cancer is commoner than in the West
EMost patients present with stage I disease
Show answer
Answer: B. Indian patients present about a decade younger, often with locally advanced disease, and triple-negative cancers make up a larger share (about a quarter in many series). There is no organised mammography programme; the national programme uses clinical breast examination for women aged 30–65.
Germline testing is LEAST justified in which newly diagnosed patient (no family history)?
AA 58-year-old with triple-negative cancer
BA 72-year-old with grade 1 ER-positive cancer
CA 55-year-old eligible for a PARP inhibitor
DA 66-year-old man
EA 44-year-old with ER-positive cancer
Show answer
Answer: B. Testing is indicated at ≤50 (ASCO-SSO extends this to ≤65), for TNBC at ≤60, for any man, for PARP-inhibitor eligibility and for strong family history. An older woman with low-grade ER-positive cancer and no family history meets none of these.
A 40-year-old who is not breastfeeding has had the appearance shown (schematic) for 5 weeks: diffuse redness over more than a third of the breast with skin dimpling, despite antibiotics. What is the diagnosis and staging category?
AInflammatory breast cancer, T4d: core and skin punch biopsy, then systemic staging
BFat necrosis: observe
CLactational mastitis: change antibiotics
DBreast abscess: incision and drainage
EEczema: topical steroids
Show answer
Answer: A. Rapid diffuse erythema and oedema (peau d'orange) over ≥⅓ of the breast is inflammatory carcinoma (T4d, at least stage III). Treatment is neoadjuvant systemic therapy, modified radical mastectomy and radiotherapy.
Under India's national NCD programme (NP-NCD), breast cancer screening for women aged 30–65 is done by:
ABiennial ultrasound
BMonthly breast self-examination only
CClinical breast examination every 5 years by trained health workers
DAnnual mammography
ESerum CA 15-3
Show answer
Answer: C. The programme offers clinical breast examination every 5 years at Ayushman Arogya Mandirs. The Mumbai cluster randomised trial showed 2-yearly CBE downstaged cancers and reduced breast cancer mortality by nearly 30% in women ≥50.
A healthy 42-year-old at average risk asks whether she should start screening mammography. The best answer is:
AScreening has no proven benefit before 50
BUltrasound alone is the best screening test at her age
CMammography every 1–2 years can be offered after discussing modest benefit and false positives
DShe should wait until menopause
EAnnual breast MRI is preferred in her 40s
Show answer
Answer: C. Trials show a 15–20% relative fall in breast cancer mortality at 40–69, with a smaller absolute benefit in the 40s and more false positives. Shared decision-making is recommended at 40–49; routine screening at 50–74.
A 30-year-old BRCA1 carrier with no cancer asks about screening. The most appropriate plan is:
AUltrasound every 5 years
BClinical breast examination only
CAnnual mammography from 40
DThermography every year
EAnnual breast MRI now, adding mammography from about 30
Show answer
Answer: E. High-risk carriers need annual MRI (typically from 25) plus mammography (typically from 30), and a discussion of risk-reducing mastectomy and salpingo-oophorectomy.
Which test should NOT be used as a substitute for screening mammography?
ADigital breast tomosynthesis
BThermography (heat scan)
CMRI in BRCA carriers
DDigital mammography
EDiagnostic mammography with ultrasound for symptoms
Show answer
Answer: B. Thermography has poor sensitivity and specificity; the FDA has warned (2011, 2023) that it does not replace mammography. Tomosynthesis is an accepted screening tool.
Answer: D. T4d is inflammatory carcinoma. T4a is chest-wall invasion (not pectoralis alone), T4b skin ulceration, satellite nodules or oedema, and T4c both. Supraclavicular nodes are N3.
Systemic staging scans (CT chest/abdomen/pelvis with bone scan, or PET-CT) are routinely indicated for:
AClinical stage I disease
BDCIS
CClinical stage III, inflammatory cancer, or symptoms suggesting metastasis
DAny patient over 50
EAll newly diagnosed patients
Show answer
Answer: C. In asymptomatic stage I–II disease the yield is low and false positives are common. Imaging is indicated for stage III, inflammatory cancer, or symptoms or abnormal labs.
Which histological type characteristically loses E-cadherin and may metastasise to the peritoneum, GI tract and meninges?
AInvasive ductal (no special type)
BInvasive lobular
CMedullary
DTubular
EMucinous
Show answer
Answer: B. Invasive lobular carcinoma (5–10%) lacks E-cadherin, is often multicentric or bilateral, relapses late and spreads to unusual sites; it can mimic a GI or ovarian primary.
Which follow-up investigation is recommended for an asymptomatic breast cancer survivor?
AAnnual mammography
BAnnual CT chest/abdomen
CAnnual CA 15-3
D6-monthly PET-CT
EAnnual bone scan
Show answer
Answer: A. Yearly mammography plus history and examination is the standard. Randomised trials (GIVIO, Rosselli Del Turco) found no survival benefit from intensive imaging or blood tests in asymptomatic patients.
A survivor on an aromatase inhibitor should routinely have:
AAnnual endometrial biopsy
BBaseline and periodic bone density assessment
CAnnual brain MRI
DMonthly lipid profile
EWeekly blood counts
Show answer
Answer: B. Aromatase inhibitors cause bone loss; DXA at baseline and every 1–2 years, calcium, vitamin D, exercise and antiresorptive therapy when indicated. Tamoxifen users should report vaginal bleeding (endometrial risk).
Which is an absolute or strong contraindication to breast-conserving therapy?
AInflammatory breast cancer
BAge under 40
CPositive axillary node
DTumour of 2.5 cm
ELobular histology
Show answer
Answer: A. Inflammatory cancer requires modified radical mastectomy even after a good response. Others include multicentric disease, diffuse suspicious calcifications, persistently positive margins and inability to receive radiotherapy.
After lumpectomy for invasive ductal carcinoma, the accepted adequate margin is:
A≥2 cm
B2 mm
CNo ink on tumour
D≥1 cm
E≥5 mm
Show answer
Answer: C. For invasive cancer treated with breast conservation and radiotherapy, “no ink on tumour” is adequate; wider margins do not lower recurrence. For pure DCIS, 2 mm is preferred.
FAST-Forward established which whole-breast radiotherapy schedule as non-inferior to 3 weeks?
A25 fractions over 5 weeks
B10 fractions over 2 weeks
C5 fractions over 1 week
D35 fractions over 7 weeks
EA single intraoperative fraction
Show answer
Answer: C. Five daily fractions over 1 week was non-inferior for local control with similar late effects at 5 years. India's HYPORT-Adjuvant trial is testing 1 week including nodal radiotherapy.
Which drug combination must NOT be given concurrently because of cardiotoxicity?
APaclitaxel with trastuzumab
BDocetaxel with carboplatin
CLetrozole with ribociclib
DCapecitabine with radiotherapy
EAnthracycline with trastuzumab–pertuzumab
Show answer
Answer: E. Concurrent anthracyclines with HER2 antibodies raised heart-failure rates. Anthracycline-free (taxane–carboplatin) HER2 regimens are favoured (TRAIN-2), and cardiac function is monitored throughout.
First-line therapy for HER2-positive metastatic breast cancer with an overall survival benefit (CLEOPATRA) is:
ATrastuzumab alone
BT-DM1
CLapatinib plus capecitabine
DTaxane plus trastuzumab plus pertuzumab
EEndocrine therapy alone
Show answer
Answer: D. CLEOPATRA showed a large overall survival gain with pertuzumab added to trastuzumab and docetaxel. Trastuzumab deruxtecan is the second-line standard (DESTINY-Breast03).
A 36-year-old woman, not breastfeeding, has had a red, warm, swollen breast for 6 weeks despite two courses of antibiotics. There is no fever and no discrete lump. Next best step?
AIncision and drainage
BReassurance and review in 3 months
CMammography, ultrasound and core biopsy with a skin punch biopsy
DA third, longer course of broad-spectrum antibiotics
EFine-needle aspiration cytology only
Show answer
Answer: C. Non-resolving “mastitis” outside lactation is inflammatory breast cancer until proven otherwise. Tissue (core plus full-thickness skin punch, looking for dermal lymphatic invasion) is needed, followed by full staging.
A 52-year-old has a unilateral scaly, itchy nipple rash for 3 months that has not improved with steroid creams. The most important next step is:
APatch testing for contact dermatitis
BA full-thickness biopsy of the nipple with breast imaging
CA topical antifungal
DReassurance
EA stronger topical steroid
Show answer
Answer: B. Persistent one-sided nipple eczema suggests Paget disease of the nipple, often associated with underlying DCIS or invasive cancer. Biopsy plus mammography/ultrasound is required.
A 45-year-old has a palpable, hard, irregular 2 cm lump. Her mammogram is reported normal (dense breasts). What next?
ARepeat mammogram in 1 year
BReassure: a normal mammogram excludes cancer
CTumour-marker (CA 15-3) estimation
DWhole-body PET-CT
EUltrasound and core biopsy
Show answer
Answer: E. About 10–15% of palpable cancers are mammographically occult, especially in dense breasts and lobular cancers. A clinically suspicious lump needs ultrasound and core biopsy regardless of the mammogram.
A 24-year-old has a 2 cm, mobile, smooth lump that has doubled in size over 3 months. Core biopsy shows a fibroepithelial lesion with stromal overgrowth. Best management?
AObservation
BExcision with a clear margin
CNeoadjuvant chemotherapy
DTamoxifen
EMastectomy with axillary dissection
Show answer
Answer: B. Rapid growth and stromal overgrowth suggest a phyllodes tumour rather than a fibroadenoma. Treatment is excision with a margin; axillary surgery is not needed because phyllodes tumours rarely spread to nodes.
The schematic H&E drawing shows small discohesive cells infiltrating in single-file lines. Which statement about this tumour type is correct?
AIt is always visible as a spiculated mass on mammography
BIt never involves both breasts
CIt is a benign proliferative lesion
DIt is typically triple-negative
EIt usually loses E-cadherin and can spread to the peritoneum, GI tract and ovaries
Show answer
Answer: E. Invasive lobular carcinoma (single-file pattern, E-cadherin loss) is usually ER-positive, more often multicentric or bilateral, can be mammographically subtle, and metastasises to unusual sites.
The correct sequence for a suspicious breast lump is:
ATumour markers, then excision
BPET-CT, then core biopsy
CFNAC, then mastectomy
DExcision biopsy, then imaging
EImaging, then core needle biopsy, then treatment planning
Show answer
Answer: E. Triple assessment (clinical examination, imaging, core biopsy) should precede any surgery. Excision before imaging and core biopsy compromises staging, receptor-guided neoadjuvant therapy and breast conservation.
A 56-year-old has the mammographic finding illustrated (schematic MLO view). Which BI-RADS category and next step fit best?
ABI-RADS 0: repeat views only, no biopsy
BBI-RADS 2: routine screening
CBI-RADS 3: repeat mammogram in 6 months
DBI-RADS 5: ultrasound-guided core biopsy
EBI-RADS 1: reassure
Show answer
Answer: D. An irregular spiculated mass with fine pleomorphic calcifications is highly suggestive of malignancy (BI-RADS 5): image-guided core biopsy with receptor testing, before any surgery.
A 34-year-old has a palpable lump; ultrasound (schematic) shows the appearance illustrated. Which feature is most suspicious?
AA hypoechoic mass taller than wide with posterior acoustic shadowing
BAn anechoic mass with posterior enhancement
CA mass with a hyperechoic fatty hilum
DAn oval, circumscribed mass parallel to the skin
EBilateral simple cysts
Show answer
Answer: A. Taller-than-wide orientation, irregular or angular margins and posterior shadowing are malignant features (BI-RADS 4–5). Oval, parallel, circumscribed masses suggest fibroadenoma; anechoic with enhancement, a simple cyst.
A 2.8 cm tumour with three mobile ipsilateral level I–II axillary nodes on ultrasound-guided biopsy and no distant metastases. What is the clinical anatomic stage?
AcT1 N1, stage IIA
BcT2 N3, stage IIIC
CcT2 N1 M0, stage IIB
DcT3 N2, stage IIIA
EcT2 N0, stage IIA
Show answer
Answer: C. 2–5 cm is T2; movable level I–II nodes are cN1; T2 N1 is stage IIB (anatomic).
A 33-year-old who completed treatment for HR-positive breast cancer 2 years ago wants to become pregnant. Which statement is correct?
AHormonal contraception is preferred until then
BEndocrine therapy can be paused for a planned pregnancy; recurrence did not rise in short-term data (POSITIVE trial)
CShe must wait 10 years
DPregnancy is absolutely contraindicated
EPregnancy cures the cancer
Show answer
Answer: B. The POSITIVE trial supports a planned interruption of endocrine therapy to attempt pregnancy, resuming afterwards. Non-hormonal contraception (e.g., a copper IUD) is advised until then.
A 55-year-old with a 2 cm tumour, clinically node-negative, has 2 positive sentinel nodes after breast-conserving surgery; whole-breast radiotherapy is planned. Further axillary management?
ANo further axillary surgery
BPET-CT before deciding
CCompletion axillary dissection
DMastectomy
EAxillary dissection plus chemotherapy
Show answer
Answer: A. ACOSOG Z0011 showed no survival benefit from completion dissection with 1–2 positive sentinel nodes when whole-breast radiotherapy is given; AMAROS supports axillary radiotherapy as an alternative.
A 58-year-old postmenopausal woman has a pT1c N0 ER-positive, HER2-negative cancer with a 21-gene recurrence score of 14. Best adjuvant systemic therapy?
ANo systemic therapy
BChemotherapy alone
CTrastuzumab
DChemotherapy then endocrine therapy
EEndocrine therapy alone
Show answer
Answer: E. TAILORx: with a score ≤25 in women over 50 (and ≤15 at any age), chemotherapy adds no benefit. An aromatase inhibitor is preferred after menopause.
A gBRCA1 carrier has residual disease after neoadjuvant chemotherapy for HER2-negative breast cancer. Which adjuvant agent improved overall survival in this setting?
AOlaparib
BEverolimus
CCapecitabine
DBevacizumab
ETrastuzumab
Show answer
Answer: A. OlympiA showed 1 year of olaparib improved invasive disease-free and overall survival in high-risk gBRCA carriers with HER2-negative disease. Capecitabine (CREATE-X) is the alternative in TNBC without a BRCA variant.
A premenopausal woman on tamoxifen develops depression. Which antidepressant should be AVOIDED because it reduces tamoxifen activation?
ACognitive behavioural therapy
BMirtazapine
CEscitalopram at low dose
DVenlafaxine
EParoxetine
Show answer
Answer: E. Strong CYP2D6 inhibitors (paroxetine, fluoxetine) block conversion of tamoxifen to endoxifen. Venlafaxine is preferred; gabapentin is a non-hormonal option for hot flushes.
A 64-year-old has new bone-only metastatic ER-positive, HER2-negative breast cancer without visceral crisis. Best first-line therapy?
ABest supportive care only
BTrastuzumab
CTamoxifen alone for 6 months
DCombination chemotherapy
EAromatase inhibitor plus a CDK4/6 inhibitor
Show answer
Answer: E. Endocrine therapy plus a CDK4/6 inhibitor improves PFS, with an overall survival benefit for ribociclib (MONALEESA-2). Chemotherapy first is reserved for visceral crisis.
A patient with breast cancer has 2 days of new leg weakness and thoracic back pain worse at night. Most urgent action?
AAnalgesia and review in a month
BBone scan next week
CStart chemotherapy immediately without imaging
DTumour-marker estimation
EDexamethasone and same-day whole-spine MRI
Show answer
Answer: E. Suspected metastatic spinal cord compression is an emergency: steroids, urgent MRI of the whole spine, and same-day spinal surgery and radiotherapy opinion. Neurological outcome depends on function at the start of treatment.
Surgery to the asymptomatic primary tumour in de novo metastatic breast cancer:
AHas not shown a survival benefit and is reserved for local symptoms
BIs mandatory before systemic therapy
CShould be combined with axillary dissection
DConsistently improves overall survival
EReplaces systemic therapy
Show answer
Answer: A. Randomised trials have not shown a consistent survival benefit; systemic therapy is the mainstay, with local treatment for fungation, bleeding or pain.
In a trial, 5-year invasive disease-free survival was 77% with a new adjuvant drug and 71% with standard therapy. Approximately how many patients need treatment to prevent one invasive recurrence or death at 5 years?
AAbout 71
BAbout 100
CAbout 6
DAbout 17
EAbout 1.1
Show answer
Answer: D. Absolute difference = 6 percentage points; number needed to treat = 1/0.06 ≈ 17. Weigh this against toxicity and cost, and look for an overall-survival effect.
DNB, DM and USMLE Step 3 level: landmark trials, newer targeted drugs and difficult decisions.
Q45DiagnosisLevel 3Presentation, traps & genetics
A 26-year-old with a 2.5 cm HER2-positive breast cancer has a sister with osteosarcoma and a mother with adrenocortical carcinoma. Which management principle changes most?
ATrastuzumab is contraindicated
BAnnual mammography from age 20 is sufficient surveillance
CShe should receive only neoadjuvant endocrine therapy
DRadiotherapy should be avoided where possible, favouring mastectomy
EShe needs no genetic testing because she is HER2-positive
Show answer
Answer: D. The family history suggests Li-Fraumeni (TP53). Radiation increases second malignancies in TP53 carriers, so mastectomy is favoured to avoid radiotherapy where possible. HER2-positive tumours are common in TP53 carriers and trastuzumab is used as usual. Surveillance relies on MRI, not mammography.
A 50-year-old has an axillary node showing adenocarcinoma; examination, mammography and ultrasound of both breasts are normal. Which is the most useful next investigation?
AUpper GI endoscopy
BBreast MRI
CColonoscopy
DCA-125
EBone marrow biopsy
Show answer
Answer: B. Isolated axillary adenocarcinoma in a woman is occult breast cancer until proven otherwise. MRI finds the primary in most cases; ER/PR/HER2 and GATA3 on the node support a breast origin.
A patient with metastatic HR-positive cancer has HER2 IHC 1+ (ISH not amplified) and has progressed on endocrine therapy. Which drug becomes an option specifically because of this HER2 result?
APertuzumab
BLapatinib
CTucatinib
DTrastuzumab
ETrastuzumab deruxtecan
Show answer
Answer: E. HER2-low (IHC 1+ or 2+/ISH−) and ultralow tumours do not benefit from classic HER2 blockade, but trastuzumab deruxtecan improved outcomes (DESTINY-Breast04 and -06).
After progression on an aromatase inhibitor plus a CDK4/6 inhibitor, ctDNA shows an ESR1 mutation. The most rational next endocrine option is:
AAn oral SERD such as elacestrant
BSwitch to a different aromatase inhibitor
CStop endocrine therapy permanently
DMegestrol only
ERe-challenge with tamoxifen first
Show answer
Answer: A. ESR1 mutations arise under AI pressure and cause ligand-independent ER activity. Oral SERDs (elacestrant, EMERALD) degrade ER and work in ESR1-mutant disease.
Which recurrence pattern is characteristic of HR-positive breast cancer compared with TNBC?
AEarly peak at 1–3 years then very low risk
BNo bone involvement
CRecurrence only in the first year
DPersistent risk extending beyond 10–20 years
EPredominantly brain-only relapse
Show answer
Answer: D. HR-positive cancers relapse steadily for 20+ years (often bone first), supporting extended endocrine therapy and long follow-up. TNBC and HER2-positive cancers relapse mostly within 3–5 years.
A woman with biopsy-proven N1 disease becomes clinically node-negative after neoadjuvant chemotherapy. The preferred axillary operation is:
AAxillary dissection in all cases
BSentinel-node biopsy with dual tracer plus removal of the clipped node
CNo axillary surgery
DAxillary radiotherapy alone without surgery
ELevel III clearance
Show answer
Answer: B. Targeted axillary dissection (sentinel nodes plus the clipped node, dual tracer) keeps the false-negative rate acceptable. Any residual nodal disease (ypN+) leads to axillary dissection.
For a left-sided breast cancer requiring radiotherapy, which technique most reduces cardiac dose for the majority of patients?
AProton therapy for all
BOmitting radiotherapy
CProne positioning in all patients
DAdding a tumour-bed boost
EDeep-inspiration breath-hold with modern photon planning
Show answer
Answer: E. Breath-hold moves the heart down and away from the field; with IMRT/VMAT and image guidance it keeps heart dose low for most patients. Protons are reserved for when photon constraints cannot be met.
Omission of radiotherapy after breast-conserving surgery is most reasonable for:
AA 74-year-old with 1.4 cm grade 1 ER-positive, node-negative cancer taking endocrine therapy
BA 50-year-old with 2 positive nodes
CA 38-year-old with grade 3 TNBC
DAny patient with clear margins
EInflammatory cancer after pCR
Show answer
Answer: A. PRIME II and CALGB 9343 showed higher local recurrence but no survival difference when radiotherapy was omitted in older women with small, low-risk, HR-positive, node-negative cancers on endocrine therapy.
Two positive sentinel nodes are found at breast-conserving surgery for a cT1 N0 tumour; whole-breast radiotherapy is planned. Which trial supports omitting axillary dissection?
ASOFT
BNSABP B-06
CCLEOPATRA
DACOSOG Z0011
EKATHERINE
Show answer
Answer: D. Z0011 showed no survival difference without axillary dissection in women with 1–2 positive sentinel nodes having breast conservation and whole-breast radiotherapy.
A 46-year-old premenopausal woman has ER-positive cancer with 2 positive nodes and a recurrence score of 18. Which statement reflects RxPONDER?
AGenomic scores cannot be used with positive nodes
BShe should receive only tamoxifen for 2 years
CShe needs trastuzumab
DChemotherapy shows no benefit regardless of menopausal status
EPremenopausal women derived benefit from chemotherapy; ovarian suppression is the debated alternative
Show answer
Answer: E. In 1–3 node disease with score ≤25, postmenopausal women gained nothing from chemotherapy, but premenopausal women did; part of the benefit may reflect chemotherapy-induced ovarian suppression.
After neoadjuvant chemotherapy with trastuzumab and pertuzumab, a patient has residual invasive disease in the breast only (nodes negative). Preferred adjuvant HER2 therapy?
ACapecitabine
BT-DM1 (trastuzumab emtansine)
CContinue trastuzumab and pertuzumab
DLapatinib
EStop HER2 therapy
Show answer
Answer: B. KATHERINE: T-DM1 reduced recurrence and improved survival versus trastuzumab for residual disease. For residual nodal disease or initially inoperable cancer, trastuzumab deruxtecan is now preferred (DESTINY-Breast05).
Abemaciclib for 2 years with endocrine therapy (monarchE) is indicated for high-risk HR+/HER2− early breast cancer. Which patient meets the monarchE high-risk definition?
ADCIS
BNode-negative, recurrence score 30
C1 positive node, tumour 2 cm, grade 2, Ki-67 10%
D4 or more positive nodes
ET1 N0, grade 3
Show answer
Answer: D. High risk was ≥4 positive nodes, or 1–3 nodes with grade 3, tumour ≥5 cm, or Ki-67 ≥20%. Ribociclib (NATALEE) has broader stage II–III eligibility.
A HER2-positive patient has progressive brain metastases on trastuzumab-based therapy. Which oral agent added to trastuzumab and capecitabine improved survival including in brain metastases?
APalbociclib
BTucatinib
CEverolimus
DNeratinib
ELapatinib
Show answer
Answer: B. HER2CLIMB showed tucatinib with trastuzumab and capecitabine improved PFS and OS, including in active brain metastases. Trastuzumab deruxtecan also has intracranial activity.
In metastatic triple-negative breast cancer with PD-L1 CPS ≥10, which first-line approach is supported by randomised data?
ASurgery of the primary tumour
BOlaparib for all patients
CEndocrine therapy
DPembrolizumab plus chemotherapy, or pembrolizumab plus sacituzumab govitecan
ETrastuzumab plus chemotherapy
Show answer
Answer: D. KEYNOTE-355 showed benefit for pembrolizumab with chemotherapy at CPS ≥10, and ASCENT-04 favoured pembrolizumab with sacituzumab govitecan. PARP inhibitors are for gBRCA carriers.
A 47-year-old premenopausal woman has pT1c N0 ER+/HER2− cancer with a 21-gene recurrence score of 21. What does TAILORx suggest about chemotherapy?
AUse trastuzumab
BRecurrence score is not valid in node-negative disease
CA small chemotherapy benefit is possible at age ≤50 with RS 16–25; discuss chemotherapy or ovarian suppression with endocrine therapy
DNo chemotherapy benefit at any age with RS 21
EChemotherapy is mandatory regardless of age
Show answer
Answer: C. In TAILORx, women aged ≤50 with RS 16–25 had some benefit from chemotherapy, possibly via ovarian suppression; options include chemotherapy or ovarian function suppression with endocrine therapy.
Prepared and reviewed by Dr. Haritha Chiramana for teaching. Facts compiled from current guidelines, primary trials and evidence summaries, written in our own words; drawings are original schematics, not patient images; no doses are included.