Chapter 13: Cancer Epidemiology

MULTIPLE CHOICE
1. Which characteristic among women correlates with a high morbidity of cancer of the colon,

uterus, and kidney?

a. Women older than 45 years of age
b. Women who have never had children
c. Women who have a high body mass index D. Woman who have smoked for more

than 10 years
ANS: C

A recent hypothesis states that the observed increased incidence of such cancers as breast,
endometrium, colon, liver, kidney, and adenomas of the esophagus may be associated with
obesity. No current research supports the remaining options.
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REF: Pages 417-418 | Figure 13-11

2. Which substance has been shown to increase the risk of cancer when used in combination

with tobacco smoking?

a. Alcohol
b. Steroids

c. Antihistamines
d. Antidepressants

ANS: A

Alcohol interacts with smoke, increasing the risk of malignant tumors, possibly by acting as a
solvent for the carcinogenic chemicals in smoke products. No current research supports the
remaining options as having an increased effect on the incidence of cancer when used in
combination with tobacco smoking.
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REF: Page 420 | Page 422

3. Which cancers pose the highest risk for radiologists?

a. Thyroid
c. Leukemia
b. Breast
d. Brain
ANS: C

Ionizing radiation exposure places radiologists at risk for the development of leukemia,
lymphoma, and skin cancers.
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REF: Page 424 | Table 13-8

4. Research has shown a link between cancer and which sexually transmitted disease?
a. Syphilis
c. Human papillomavirus
b. Gonorrhea
d. Pelvic inflammatory disease
ANS: C

Human papillomavirus (HPV) is the most common sexually transmitted virus in the United
States. High-risk, or oncogenic, HPVs can cause cancer. A persistence of infection with highrisk HPV is a prerequisite for the development of cervical intraepithelial neoplasia (CIN)
lesions and invasive cervical cancers. No research supports such a link between the remaining
options and cancer.

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REF: Pages 423-424

5. Research has supported that alcohol consumption has a convincing impact on increasing the

risk of which cancer?

a. Lung
b. Breast

c. Pharynx
d. Pancreas

ANS: C

Research had shown that alcohol consumption has a convincing positive impact on the risk of
developing pharynx cancer. No research supports such a connection with the remaining
options.
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REF: Page 422 | Table 13-5

6. Research supports the premise that exercise has a probable impact on reducing the risk of

which cancer?
a. Liver
b. Endometrial

c. Stomach
d. Colon

ANS: D

The World Cancer Research Fund summarizes the effects as convincing for cancers of the
colon and probable for postmenopausal breast cancer and endometrial cancer. The
relationship is not supported for the remaining options.
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REF: Page 422 | Table 13-6

7. The World Health Organization (WHO) defines grade 1 (overweight) as a BMI of:
a. 18.5 to 24.9
c. 30 to 39.9
b. 25 to 29.9
d. 40 to 50.9
ANS: B

A BMI of 25 to 29.9 kg/m2 is considered a grade 1 (overweight) classification. A BMI of 18.5

to 24.9 kg/m2 is considered normal range, whereas 30 to 39.9 kg/m2 is a grade 2 (severe
overweight) classification, and a BMI higher than 40 kg/m2 is considered grade 3 (morbidly
overweight).
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REF: Page 418 | Table 13-4

MULTIPLE RESPONSE
8. Tobacco smoking is associated with which cancers? (Select all that apply)
a. Lung
b. Skin
c. Bladder
d. Kidney
e. Pancreas
ANS: A, C, D, E

Besides lung cancer, tobacco increases the risk for cancers of the mouth, lips, nasal cavity and
sinuses, larynx, pharynx, esophagus, stomach, pancreas, kidney, bladder, uterus, cervix, colon
and rectum, ovary, and acute leukemia. No current research links tobacco smoking to skin
cancer.
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REF: Page 413

9. The significant risk factors associated with the development of basal cell carcinoma include:

(Select all that apply.)

Light-colored hair
Pale eyes
Fair skin
Freckles
History of acne

a.
b.
c.
d.
e.

ANS: A, B, C, D

Risk factors associated with a high risk of melanoma include light-colored hair, eyes, and
skin; an inability to tan; and a tendency to freckle, sunburn, and develop nevi. No current
research supports acne as a risk factor.
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REF: Page 431

10. Which environmental factors have been shown to have greatest significant effect on the

frequency of genetic mutations in humans? (Select all that apply.)

Tobacco use
Radiation exposure
Obesity
Severe allergies
Stressful occupation

a.
b.
c.
d.
e.

ANS: A, B, C

The number of environmental factors can alter the frequency and consequences of genetic
mutations. The most significant factors include smoking, radiation, obesity, and a few
oncogenic viruses. Allergies and stress have not been strongly linked as risk factors for
genetic mutations.
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REF: Pages 413-433

11. Research data support the relationship between the exposure of ultraviolet light (UVL) and the

development of: (Select all that apply.)

Basal cell carcinoma
Squamous cell carcinoma
Hodgkin lymphoma
Non-Hodgkin lymphoma
Soft-tissue sarcoma

a.
b.
c.
d.
e.

ANS: A, B

Exposure to UVL can cause basal cell carcinoma and squamous cell carcinoma. No current
research supports a causative relationship between the remaining options and UVL exposure.
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REF: Page 431

12. Alcohol consumption has been proven to be a consistent risk factor in the development of

which major cancer? (Select all that apply.)

Colorectal
Kidney
Breast
Esophageal
Pancreatic

a.
b.
c.
d.
e.

ANS: A, C, D

Research supports a consistent link between alcohol consumption and an increased risk for
breast, colorectal, and esophageal cancers; no such data have yet been determined for the
remaining options.
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REF: Page 420

13. Nutritional counseling regarding cancer stem cell repopulation must stress the importance of

including sufficient quantities of what in a daily diet? (Select all that apply.)
Vitamin A
Vitamin D
Protein
Vitamin C
Water

a.
b.
c.
d.
e.

ANS: A, B

Cancer stem cells use several developmental mechanisms for the self-renewal, and these
mechanisms appear to be fundamental to the initiation and recurrence of tumors. Adequate
consumption of specific food compounds, including vitamin A and D, genistein, green tea
epigallocatechin gallate (EGCG), sulforaphane, theanine, curcumin, and choline may suppress
cancer stem renewal. No current research supports such a connection with the other options.
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REF: Page 416

14. Which personal lifestyle choices will likely have a positive impact on reducing an individuals

risk for developing cancer? (Select all that apply.)

Avoiding crowds
Wearing a hat while golfing
Eating a strict vegetarian diet
Having regular health screenings
Staying indoors during smog alerts

a.
b.
c.
d.
e.

ANS: B, E

Avoiding exposure to ultraviolet radiation and air pollutants will help decrease the risk of
developing skin and lung cancer. Although avoiding crowds may reduce the risk of
contracting infections, no research suggests such a decision will reduce the risk of cancer.
Eating a vegetarian diet will reduce the consumption of red meat, but no research suggests that
such a diet is a factor in reducing the risk of cancer. Health screening, although important, can
detect the possible presence of a specific disease, but it does not prevent diseases.
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REF: Page 431 | Page 433

15. Which individual is at risk for developing lung and respiratory tract cancers because of

exposure to known cancer-inducing environmental factors? (Select all that apply.)

A patient whose partner smokes 1 1/2 packs of cigarettes a day
A 10-year employee of an asbestos fiber manufacturer
A farmer whose equipment is primarily driven by diesel engines
An older adult with a family history of lung cancer and chronic obstructive
pulmonary disease (COPD)
e. A 10-year delivery employee for a paper manufacturing company
a.
b.
c.
d.

ANS: A, B, C, E

Numerous environmental factors can cause inflammation and include, for example, inhaling
tobacco smoke, asbestos fibers, or fine particles in the air from diesel engine exhaust and
industrial sources. Sulfur dioxide is produced by power plants burning oil and coal, copper
smelting, and paper mills. These sources are major factors in lung and other respiratory tract
cancers. A family history is not considered a risk factor since these cancers are generally
affected by environmental rather than genetic factors.
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REF: Page 403 | Page 433

16. Which primary prevention strategy has a substantial likelihood of reducing the risk of

developing cancer? (Select all that apply.)

Offering free smoking cessation classes to college students
Establishing a support group for patients receiving chemotherapy
Providing a breast cancer screening at a senior center twice a year
Supplying low sugar, low-fat snacks at an after-school tutoring program
Funding a support service that offers transportation to cancer treatment centers

a.
b.
c.
d.
e.

ANS: A, C, D

Targeted interventions can substantially reduce the incidences of cancers worldwide and
should include primary prevention strategies to decrease or eliminate certain lifestyle factors
including tobacco avoidance and the cessation of smoking, a reduction in obesity and alcohol
consumption, an increase in physical activity, and the implementation of vaccination programs
for liver and cervical cancer, as well as effective early detection programs for colorectal,
breast, and cervical cancer. Support groups and transportation to cancer centers are secondary
strategies.
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REF: Page 409 | What's New box

17. When considering topics for a series of community discussions related to cancer prevention

strategies, the nurse will include: (Select all that apply.)

Healthy eating
Tobacco avoidance
Importance of early diagnosis
Impact of obesity on ones health
Age-appropriate exercise routines

a.
b.
c.
d.
e.

ANS: A, B, D, E

Eliminating smoking, decreasing obesity, participating in appropriate exercises, eliminating

infections, and avoiding an unhealthy diet are all essential for preventing cancer. Screening is
not a prevention strategy.

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REF: Page 412 | What's New box