Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Breast Health Overview (available online: lghealth.org/breastguidelines) Risk Assessment Online risk breast cancer risk Profiler, based on Gail Model At Suzanne B. Arnold Center for Breast Health: Will be using BRCA PRO model Comprehensive review, counseling and genetic testing: Cancer Risk Evaluation Program (CREP) at Cancer Institute Risk Stratifications: Very High Risk: mammography screening begins at age 40 or ten years prior to age of affected relative. Annual MRI and referral to CREP should be considered. Patient with: • Known BRCA positive status • Family history of BRCA positive relatives, male breast cancer or ovarian cancer • History of chest wall radiation (for example, for Hodgkin's disease) between ages 10 and 30 High Risk: Mammogram yearly starting at age 40 until life expectancy <10 years. Referral to CREP should be considered. Patient with: • Personal history of breast cancer • Family history of breast cancer before age 50, or in both breasts or in several close relatives • History of prior biopsy-proven LCIS, ALH or ADH • If calculated lifetime risk > 20%, consider annual MRI Average Risk: Recommend screening with a harms/benefits discussion to help decide between yearly beginning at 40, until life expectancy <10 years vs AAFP recommendation of at least every 2 years for women 50-74. Patient with: • Calculated lifetime risk around the average for a 60 yr old woman at 9.1% Current Screening Recommendations: • ACS/NCCN yearly beginning at age 40 for as long as a woman is in “good health” ACOG 2011 yearly beginning age 40 ASBS 8/2011 yearly beginning age 40 ASCO 2013 yearly after breast cancer treatment ACR 2012 yearly beginning age 40 for < 15% lifetime risk, high risk > 20% or personal or family history of BRCA gene mutation, history chest XRT: begin 25 – 30 or 10 years before first relative, 8 years after XRT, with yearly MRI AAFP 2/2013 Offered at least biennially to women 50 – 74 for 40 – 49 the risks and benefits of screening should be discussed > 75 the decision should be individualized keeping life expectancy and goals of care in mind Teaching BSE not recommended, however women should report any changes in their breasts promptly 2009 USPSTF (US Preventive Services Task Force) Recommended against routinely screening women younger than 50 Recommended women under 50 discuss when to begin screening with their physician Recommended screening every 1 – 2 years between ages 50 and 74 Suggested Discussion Points for Informed Decision Making About Mammography Screening* • • • • • • Mammography is not a perfect screening test, and understanding of its benefits and harms Ii incomplete Some cancers will be missed, and some women will die of breast cancer regardless of whether they are screened. Most women diagnosed with breast cancer will be cured regardless of whether the cancer was found by a screening mammogram or on an exam. Some cancers that are found may have never progressed to cause death. This is called “overdiagnosis.” Data on this is very controversial because we have no tools that let us predict which tumors would progress so all information is based on statistical modeling only. Often women who have screening mammograms are called back for further testing because of an abnormality that proves not to be a cancer; this is called a “false-positive” result. Studies of the benefits and harms of mammography have limitations and inconsistent results. The numbers reported below are estimates based on what most experts consider the best available evidence, but uncertainty about these estimates remains. Benefits of Mammography • • • Mammography decreases the number of women who will die from breast cancer. This benefit is greater for women who are at higher risk for breast cancer based on older age or other risk factors such as family history. The number of women whose lives are saved because of mammography varies by age. If your breast cancer risk is higher than average, you may benefit more from a mammogram than someone with average risk. Harms of Mammography • • Many women who have a mammograms will have had a false-positive mammogram requiring additional testing ( 2013 SBABC recall rate was 9.6% of screening mammograms). For some women undergoing regular screening, the mammogram may identify an invasive cancer or noninvasive condition (ie, ductal carcinoma in situ) that would have never put the woman at risk of dying. (“overdiagnosis”). We cannot currently tell which cancers these are, so all cancers are treated the same way. Intelligent people disagree on how frequently this happens. Making a Decision About Mammography • • • There is no disagreement among experts that mammograms save lives, and that at the very least women aged 50 to 74 years should undergo a screening mammogram every 2 years. A large body of data suggesting that more lives may be saved with a yearly mammogram starting at age 40 also exists. Whether you are likely to benefit from starting mammograms earlier or having them more frequently depends on your risks for breast cancer. Each woman may feel differently about the possibility of having a false-positive result or being diagnosed with and treated for cancer that might not have caused problems. It is important for you to consider what these experiences might mean for you. It is also important to consider how you might feel if you decide not to undergo screening mammography and you are later diagnosed with breast cancer. * A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions Lydia E. Pace, MD, MPH1; Nancy L. Keating, MD, MPH2,3 JAMA. 2014;311(13):1327-1335. doi:10.1001/jama.2014.1398