656 Obstetrics and Gynecology Board Review •••
❍ What are the risks of breast cancer?
Age, early onset menarche, low parity, late menopause, Ashkenazi Jewish heritage, and familial disease: BRAC,
Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome.
❍ What is the Gail model and what is it used for?
It is a risk assessment tool that incorporates the patient’s age, family history of breast cancer, history of breast
biopsy, and reproductive factors to assess the 5-year risk of breast cancer. If the risk is 1.7% or greater, this indicates
a need for increased screening.
❍ What patients are in need of increased screening?
Patients who have a lifetime risk of breast cancer of 20% or greater, and history of breast biopsy with atypical
hyperplasia and lobular carcinoma in situ.
❍ What is appropriate for increased screening?
Self-breast examinations, biannual clinical breast examinations, annual mammography, and annual MRI.
❍ What is the triple screen and how sensitive is it in detecting Down syndrome?
The triple screen is a test performed prior to 20 weeks’ gestation that incorporates maternal serum alpha fetal
protein (MSAFP), estriol, and human chorionic gonadotropin (hCG) to calculate the risk of aneuploidy. The test
is 70% effective in detecting Down syndrome.
❍ What is the quad screen and how sensitive is it in detecting Down syndrome?
The quad screen incorporates the triple screen in addition to testing inhibin A levels, which increases the sensitivity
to 80%.
❍ What changes are seen in analytes of a Down fetus?
MSAFP decreases by 0.74, estriol decreases by 0.75, hCG increases by 2.06, and inhibin increases by 1.77.
❍ What analytes are used in evaluation of trisomy 18 and how are these markers affected?
MSAFP, estriol, and hCG are all decreased, while inhibin A is not used in screening for trisomy 18.
❍ What is the integrated screen?
This study measures the nuchal translucency (NT) (fluid collection on the fetal neck) plus PAPP-A and b-hCG
in the first trimester and combines these results with second-trimester measurements of inhibin A, MSAFP, and
unconjugated estriol.
❍ What is the sensitivity of the integrated screen and the sequential screen with NT?
94% to 95%.
❍ What is the disadvantage of the integrated screen?
Patients have to wait 3 to 4 weeks for results, lose the opportunity for CVS, and possibly become lost to follow-up.