Gynecology Book

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Breast Cancer Screening

Aka: Breast Cancer Screening, Screening for Breast Cancer
  1. See Also
    1. Breast Cancer Risk Factors
    2. Breast Cancer Gene Marker Testing Indications
  2. Efficacy: Overall
    1. Screening contributed to 23% less mortality 1990-2000
  3. Guidelines: Available Screening Modalities
    1. Breast Self Exam (BSE)
    2. Clinical Breast Examination (CBE)
    3. Mammogram
    4. Breast Cancer Gene Marker (BRCA1 or BRCA2)
    5. Breast MRI
    6. Breast Specific Gamma Imaging (BSGI)
      1. New cardiolite-based modality
      2. Significantly improves on efficacy compared with old scintimammography
      3. Indicated in hyperdense Breasts or moderate risk patients not meeting criteria for Breast MRI
  4. Guidelines: Low Risk Screening
    1. Ages 20-39 years
      1. Monthly Breast Self Exam (BSE)
      2. Clinical Breast Examination (CBE) every 1-3 years
    2. Age 40-49 years
      1. Monthly Breast Self Exam (BSE)
      2. Clinical Breast Examination (CBE) every year
      3. Mammogram every 1-2 years
        1. USPSTF Strength of Recommendation: C
        2. Recent study suggests annual screening
          1. Lower Incidence of advanced cancer at diagnosis
          2. White (2004) J Natl Cancer Inst 96:1832-9
    3. Age 50 and over
      1. Monthly Breast Self Exam (BSE)
      2. Clinical Breast Examination (CBE) every year
      3. Mammogram annually
        1. USPSTF Strength of Recommendation: A
    4. Age 65 and over
      1. Monthly Breast Self Exam (BSE)
      2. Clinical Breast Examination (CBE) every year
      3. Mammogram every 2 years
        1. Consider less frequent if reduced life expectancy
      4. References
        1. Mandelblatt (2003) Ann Intern Med 139:835-42
    5. Age to stop screening
      1. No guideline offers specific age
      2. American Geriatric Association recommends stopping screening when life expectancy <4 years
  5. Guidelines: Adjusted for Family History
    1. Strong Family History (Lifetime risk over 20%)
      1. Criteria
        1. One first degree relative with Breast Cancer OR
        2. Two distant relatives with Breast Cancer
      2. Screening Guidelines
        1. Clinical Breast Exam
          1. Annual exam for women over age 25 years
          2. Breast Exam every 6 months after age 30 years
        2. Mammogram
          1. Annually after age 35 years or
          2. Five years before youngest affected relative
        3. Breast MRI (consider)
          1. Annually starting at age 30 years
    2. High Risk (Lifetime Risk: 20-85%)
      1. See Breast Cancer Gene Marker Testing Indications
      2. Criteria
        1. Breast Cancer Gene Marker (BRCA1 or BRCA2) Carrier
        2. Known Breast Cancer Syndrome
        3. Very Strong Family History
          1. Two or more affected first degree relatives
            1. Breast Cancer
            2. Ovarian Cancer
          2. One first degree relative under age 40 years
          3. Affected premenopausal first degree relative
      3. Screening Guidelines
        1. Clinical Breast Exam
          1. Every 6 months after age 25 years
        2. Mammogram
          1. Annually after age 25 years
        3. Breast MRI
          1. Consider annually starting at age 30 years
  6. Guidelines: Adjusted for Past Medical History
    1. Atypical Hyperplasia
      1. Negative Family History (Lifetime Risk: 15-20%)
        1. Annual Clinical Breast Exam
        2. Annual Mammogram
      2. Positive Family History (Lifetime Risk over 20%)
        1. Clinical Breast Exam every 6 months
        2. Annual Mammogram: after age 40 or after diagnosis
        3. Breast MRI: Starting at age 30 years (consider)
    2. Lobular Carcinoma in situ (Lifetime Risk 20-30%)
      1. Clinical Breast Exam every 6 months
      2. Annual Mammogram after diagnosis
      3. Breast MRI: Consider starting at age 30 years
  7. Efficacy: Sensitivity of Mammogram and Clinical Breast Exam
    1. Mammogram: 40% of detected cancers
    2. Clinical Breast Exam: 5-15% of detected cancers
    3. Mammogram AND Exam: 45% of detected cancers
  8. References
    1. Knutson (2007) Am Fam Physician 75:1600-6
    2. Leitch (1997) CA Cancer J Clin 47:150-3
    3. Smith (2000) CA Cancer J Clin 50:34-49
    4. Zoorob (2001) Am Fam Physician 63(6):1101-12
    5. (1997) ACOG Opinion, no. 185

Screening for malignant neoplasm of breast (C0281182)

Definition (NCI) Early detection of breast cancer involving asymptomatic women. Generally done in the population with higher risk, due to environmental or genetic factors.
Definition (NCI) Use of a device, marker, or other means for the purpose of detecting the presence of a breast tumor early in its development.
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 268547008, 148395005, 171174009
English Breast neoplasm screen, Breast neoplasm screen NOS, Early Detection of Breast Cancer, Screening for malignant neoplasm of breast (procedure), Breast neoplasm screening, Breast neoplasm screening (procedure), Screening for malignant neoplasm of breast, breast screening for cancer, screening breast neoplasm, breast screening cancer, screening breast cancer, breast cancer screen, breast cancer detection early, early breast cancer detection, early detection breast cancer, screening for breast cancer, breast cancer early detection, breast cancer screening, early detection of breast cancer, Breast Cancer Screening, Breast Cancer Early Detection, Screening for Breast Cancer
Spanish detección selectiva de neoplasia de mama (procedimiento), cribaje para la detección de neoplasia de mama, rastreo para la detección de neoplasia de mama, tamizaje para la detección de neoplasia de mama, pesquisa para la detección de neoplasia de mama, screening para la detección de neoplasia de mama, Breast neoplasm screen, cribado para la detección de neoplasia mamaria (procedimiento), screening de neoplasia de mama, tamizaje de neoplasia de mama, cribado para la detección de neoplasia mamaria, pesquisa de neoplasia de mama, detección selectiva para neoplasia de mama, cribado para la detección de neoplasia de mama, cribado de neoplasia de mama, detección selectiva de neoplasia de mama
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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