Cancer Screening and Prevention — MCQs
Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?
Which of the following attributes are essential for an ideal screening test?
At what age is the first dose of Measles vaccination given under the Universal Immunization Programme (UIP)?
All are premalignant conditions of oral cavity except:
Secondary prevention is applicable to
Which of the following is NOT considered a premalignant lesion of the oral cavity?
A sexually active 16-year-old presents for STI screening with recent assault history, multiple partners, inconsistent condom use. Which comprehensive prevention strategy is most appropriate?
Screening is not useful in which carcinoma
Which is the most common tumor leading to death in adults?
Metastases from follicular carcinoma should be treated by:
Cancer Screening and Prevention Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?
- A. Office endometrial washing for endometrial cancer
- B. USG in endometrial cancer
- C. CA-125 for ovarian cancer (Correct Answer)
- D. Pap smear for cervical cancer
Explanation: ***CA-125 for ovarian cancer*** - While elevated in some ovarian cancers, **CA-125 lacks sufficient sensitivity and specificity** as a stand-alone screening tool for early detection in asymptomatic women. - Its use for general population screening has **not been shown to reduce mortality** from ovarian cancer and can lead to **false positives** and unnecessary invasive procedures. - Major trials (UKCTOCS, PLCO) have not demonstrated mortality benefit from CA-125 screening. *Office endometrial washing for endometrial cancer* - While this involves collecting cells from the uterine lining for cytological analysis, **endometrial washing/cytology has poor sensitivity** and is not established as an effective screening method. - However, it has shown **some promise in research settings** for high-risk individuals, though it is not a standard or widely recommended screening approach. - **Endometrial biopsy** remains the gold standard for diagnosis in symptomatic women, but routine screening of asymptomatic women is not recommended. *USG in endometrial cancer* - **Transvaginal ultrasonography (TVUS)** can effectively measure **endometrial thickness** and is valuable for evaluating postmenopausal bleeding. - While not used for population-based screening of asymptomatic women, it aids in **risk stratification** and guiding further investigation like biopsy in symptomatic patients. - When used appropriately in symptomatic women, TVUS is a useful diagnostic adjunct. *Pap smear for cervical cancer* - The **Pap smear** is a highly effective and widely adopted screening method for **cervical cancer**, detecting precancerous and cancerous changes in cervical cells. - Its widespread use has **significantly reduced the incidence and mortality rates** of cervical cancer due to its ability to identify abnormalities early, allowing for timely intervention. - This is the gold standard for cancer screening with proven mortality benefit.
Question 2: Which of the following attributes are essential for an ideal screening test?
- A. Safe
- B. Reliable
- C. Valid
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - An ideal screening test must possess **all three essential attributes**: safety, reliability, and validity. - **Safe**: Minimizes harm to participants and ensures ethical implementation - **Reliable**: Produces consistent, reproducible results with minimal random error - **Valid**: Accurately measures what it intends to measure (high sensitivity and specificity) - These three attributes work together as fundamental requirements for any effective screening program, ensuring that early detection benefits outweigh potential risks. *Safe (alone)* - While safety is absolutely essential, it is **not sufficient by itself** to make an ideal screening test. - A test that is safe but unreliable or invalid would produce inconsistent or inaccurate results, rendering it ineffective for screening purposes. *Reliable (alone)* - Reliability ensures consistent results, which is crucial, but **reliability alone is insufficient**. - A test can be highly reliable (consistently giving the same result) yet completely invalid if it measures the wrong thing or is unsafe. *Valid (alone)* - Validity is critical for accurate measurement, but **validity alone does not make a test ideal**. - Even a valid test must be safe to protect participants and reliable to ensure consistency across different settings and times.
Question 3: At what age is the first dose of Measles vaccination given under the Universal Immunization Programme (UIP)?
- A. 10 weeks
- B. 9 months (Correct Answer)
- C. 14 weeks
- D. 6 months
Explanation: ***9 months*** - The first dose of the **Measles-Rubella (MR) vaccine** is given at **9 months of age** as per India's Universal Immunization Programme (UIP). - This timing is chosen because **maternal antibodies** against measles, which can interfere with vaccine effectiveness, generally wane by this age. - A second dose is given at **16-24 months** to ensure adequate protection (Note: Some countries use MMR vaccine which includes mumps component as well). *10 weeks* - This age is associated with the administration of other routine vaccinations like **Pentavalent vaccine (DPT-HepB-Hib)** and **OPV/IPV**, not measles. - Administering the measles vaccine too early, when **maternal antibodies** are still high, leads to suboptimal immune response. *14 weeks* - This is when the **third dose of Pentavalent vaccine and OPV/IPV** are given as part of the routine immunization schedule. - This age is not the standard recommendation for initial measles vaccination. *6 months* - While specific high-risk situations (e.g., outbreaks or travel to endemic areas) might warrant an additional measles vaccine dose at 6 months, it is **not the routine recommended age** for the first dose. - At 6 months, there may still be sufficient **maternal antibodies** to interfere with vaccine efficacy, leading to poorer immune response compared to vaccination at 9 months. - If given at 6 months during outbreaks, the child still receives routine doses at 9 months and 16-24 months.
Question 4: All are premalignant conditions of oral cavity except:
- A. Oral submucosal fibrosis
- B. Oral lichen planus (Correct Answer)
- C. Leucoplakia
- D. Chronic hyperplastic candidiasis
Explanation: ***Oral lichen planus*** - While certain forms of **oral lichen planus (OLP)**, particularly the erosive type, are considered to have a small potential for malignant transformation, it is generally considered a **potentially malignant disorder** rather than a definitively premalignant condition with high rates of progression. - Its transformation rates are significantly lower and less consistent across studies compared to other conditions listed. *Oral submucosal fibrosis* - This is a well-established **premalignant condition** characterized by chronic, progressive fibrotic changes in the oral mucosa, primarily due to **areca nut chewing**. - It has a high malignant transformation rate, particularly into **oral squamous cell carcinoma**. *Leucoplakia* - This is defined as a white plaque of the oral mucosa that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - It is histologically often associated with **epithelial dysplasia** and has a significant risk of developing into **oral squamous cell carcinoma**, making it a definitive premalignant condition. *Chronic hyperplastic candidiasis* - This is a form of **mucocutaneous candidiasis** that presents as a persistent white plaque that cannot be scraped off. - Unlike other forms of candidiasis, it is considered a **premalignant lesion** with a potential for malignant transformation, especially if associated with epithelial dysplasia.
Question 5: Secondary prevention is applicable to
- A. Early stage of disease (Correct Answer)
- B. Factors leading to disease
- C. Advanced stage of disease
- D. None of the options
Explanation: ***Early stage of disease*** - **Secondary prevention** focuses on early detection and prompt treatment to halt the progression of an existing disease. - This stage is crucial for interventions like **screening tests** and **early diagnosis**, which aim to minimize the impact of the disease once it has begun. *Factors leading to disease* - This relates to **primary prevention**, which aims to prevent the disease from occurring in the first place by addressing risk factors or promoting health. - Examples include **vaccination** or promoting healthy lifestyle choices. *Advanced stage of disease* - This is the domain of **tertiary prevention**, which focuses on managing the disease, preventing complications, and improving quality of life once the disease is well-established. - Rehabilitation and long-term care are key aspects of this stage. *None of the options* - This option is incorrect because secondary prevention specifically targets the **early stage of disease** to prevent further progression and adverse outcomes.
Question 6: Which of the following is NOT considered a premalignant lesion of the oral cavity?
- A. Desquamative gingivitis (Correct Answer)
- B. Erythroplakia
- C. Proliferative verrucous leukoplakia
- D. Chronic hyperplastic candidiasis
Explanation: **Desquamative gingivitis** - While it can be a manifestation of certain immune-mediated conditions (e.g., **lichen planus**, **pemphigoid**), desquamative gingivitis itself is not inherently a premalignant lesion. - It is characterized by sloughing, redness, and ulceration of the gingiva, which are symptoms of inflammation and epithelial separation, not necessarily precancerous changes. *Erythroplakia* - **Erythroplakia** is a velvety red patch that cannot be characterized clinically or pathologically as any other recognizable lesion. - It has a very **high rate of malignant transformation** (up to 90% when dysplastic), making it one of the most serious premalignant oral lesions. *Proliferative verrucous leukoplakia* - **Proliferative verrucous leukoplakia (PVL)** is a distinct, aggressive form of leukoplakia characterized by multiple, often widespread, white plaques with a **verrucous or papillary surface**. - It has a high rate of recurrence and a **very high tendency for malignant transformation**, often progressing to squamous cell carcinoma. *Chronic hyperplastic candidiasis* - **Chronic hyperplastic candidiasis** (also known as candidal leukoplakia) is a form of candidiasis that appears as a persistent white plaque. - It is considered a **potentially malignant disorder** because the candidal infection can induce epithelial dysplasia, which may transform into squamous cell carcinoma.
Question 7: A sexually active 16-year-old presents for STI screening with recent assault history, multiple partners, inconsistent condom use. Which comprehensive prevention strategy is most appropriate?
- A. HPV vaccination, counseling, PrEP evaluation, and regular screening (Correct Answer)
- B. Condoms and annual screening
- C. Single STI screen and treatment if needed
- D. Abstinence counseling only
Explanation: ***HPV vaccination, counseling, PrEP evaluation, and regular screening*** - This option offers a **comprehensive approach** addressing multiple risk factors and potential exposures, including **vaccination** for HPV, **counseling** for risk reduction, **PrEP evaluation** for HIV prevention due to multiple partners and inconsistent condom use, and **regular screening** for early detection. - The patient's history of **sexual assault**, **multiple partners**, and **inconsistent condom use** necessitates a multi-faceted prevention strategy that goes beyond basic screening. *Condoms and annual screening* - While **condoms** are essential for preventing STIs, and **annual screening** is important, this strategy is not comprehensive enough given the patient's high-risk profile (multiple partners, inconsistent condom use, sexual assault history). - It omits important preventive measures like **HPV vaccination** and consideration for **PrEP**, which are crucial for this patient's age and risk factors. *Single STI screen and treatment if needed* - A **single STI screen** is insufficient as it only provides a snapshot of current infections and does not incorporate **prevention strategies** for future encounters or address the ongoing risk factors. - This approach fails to provide **proactive protection** through vaccination or PrEP and does not include ongoing counseling for risk reduction. *Abstinence counseling only* - While **abstinence** is the most effective way to prevent STIs, relying solely on **abstinence counseling** is often unrealistic and insufficient for a sexually active individual, especially one with a history of sexual assault and current high-risk behaviors. - This option completely disregards the need for **medical interventions** like vaccination, PrEP, and regular screening that are vital for this patient's health.
Question 8: Screening is not useful in which carcinoma
- A. Testicular carcinoma (Correct Answer)
- B. Carcinoma prostate
- C. Carcinoma colon
- D. Carcinoma breast
Explanation: Testicular carcinoma - **Testicular cancer** typically presents as a painless mass, and **self-examination** is often emphasized for early detection rather than formal screening programs due to low incidence and variable benefits. - While early detection is important, population-wide screening for testicular cancer is **not recommended** due to its rarity and lack of evidence for improved outcomes compared to opportunistic detection. *Carcinoma prostate* - **Prostate cancer screening** using **PSA (prostate-specific antigen)** testing and digital rectal examinations is routinely performed, though its benefits and risks are debated [1]. - Early detection aims to identify potentially aggressive cancers, but also leads to **overdiagnosis and overtreatment** of indolent lesions [1]. *Carcinoma colon* - **Colorectal cancer screening** is highly effective and widely recommended through methods like **colonoscopy**, fecal occult blood testing, and sigmoisingoscopy. - Screening aims to detect **polyps** before they become cancerous or find cancer at an early, treatable stage, significantly reducing mortality. *Carcinoma breast* - **Breast cancer screening** using **mammography** is a well-established and highly effective method for early detection in women. - Early detection allows for timely treatment, significantly improving prognosis and reducing breast cancer mortality.
Question 9: Which is the most common tumor leading to death in adults?
- A. Lung cancer (Correct Answer)
- B. Prostate cancer
- C. Colorectal cancer
- D. Leukemia
Explanation: ***Lung cancer*** - **Lung cancer** is the most common cause of cancer-related death in both men and women worldwide [1], [2]. - Its high mortality is attributed to its aggressive nature, late diagnosis, and limited treatment options for advanced stages [3]. *Prostate cancer* - While **prostate cancer** is very common in men, it typically has a slower progression and a relatively high survival rate compared to lung cancer. - Early detection through screening often leads to successful treatment and a good prognosis. *Colorectal cancer* - **Colorectal cancer** is a significant cause of cancer mortality but ranks behind lung cancer in overall deaths [2]. - Improved screening methods like colonoscopies allow for early detection and removal of precancerous polyps, reducing mortality. *Leukemia* - **Leukemia** refers to cancers of the blood and bone marrow, and while serious, they are less common causes of cancer death than solid tumors like lung, colorectal, or prostate cancer [2]. - Advances in chemotherapy, stem cell transplantation, and targeted therapies have significantly improved survival rates for many types of leukemia.
Question 10: Metastases from follicular carcinoma should be treated by:
- A. Radioiodine (Correct Answer)
- B. Surgery
- C. Thyroxine
- D. Observation
Explanation: ***Radioiodine*** - **Differentiated thyroid cancers**, including **follicular carcinoma**, retain the ability to uptake iodine, making **radioiodine (I-131) therapy** highly effective for treating metastases [1]. - This therapy targets and destroys thyroid cancer cells wherever they are located in the body, including distant metastatic sites. *Surgery* - While surgery (e.g., **thyroidectomy**) is the primary treatment for localized thyroid cancer and can be used to resect some metastases, it is **not always feasible** for all metastatic sites, especially widely disseminated disease. - Surgery for widespread metastases carries significant risks and may not be curative if all tumor burden cannot be removed. *Thyroxine* - **Thyroxine (T4)** replacement therapy is crucial after thyroidectomy to replace missing hormones and to **suppress TSH** production, which can stimulate residual cancer growth [1]. - However, thyroxine itself does **not directly destroy** existing metastases; it's a supportive and suppressive therapy, not a primary treatment for metastases. *Observation* - **Observation** is generally not appropriate for treating metastases from **follicular carcinoma**, as these metastases have the potential to grow and lead to significant morbidity and mortality if left untreated. - Active treatment is usually indicated to improve prognosis and quality of life.
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