Download Screening Guidelines - Susan G Komen Columbus

Introduction: When to screen?
◦ Komen’s Response
 Komen Recommendations:
◦ Mammography
◦ CBE
◦ BSA
◦ Highlighting at Risk Groups
◦ What to Do With High Risk Groups
 Overview
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There has been a long standing debate about when to begin
mammography screening and how frequently it should be done.
Like any screening, tool, considerations of benefits and risks must
be taken into account.
Despite extensive scientific evidence demonstrating that
mammography reduces breast cancer mortality both among women
aged 50 and older as well as women 40-49, in November 2009 the
United State Preventive Services Task Force released new
recommendations for mammography screening, including:
◦ Biennial screening for women 50- 74
◦ There may be no additional benefit to screening women 75 and older
 From the Susan G. Komen for the Cure Scientific Advisory Board Regarding
U.S. Preventive Services Task Force (USPSTF) Recommendations on Breast
Screening (November 16, 2009)
For more information on the
controversy, click here

“Mammography is not perfect, but is still our best tool for early
detection and successful treatment of this disease. New screening
approaches and more individualized recommendations for breast
cancer screening are urgently needed. Susan G. Komen for the
Cure is currently funding research initiatives designed to improve
screening, and we believe that it is imperative that this research
move forward rapidly. Komen also provides funding for education,
awareness and screening programs in more than 1,900
communities.”
◦ Until Science Improves, Current Screening Recommendations
Should Remain, World’s Leading Breast Cancer Organization
Reports DALLAS – November 16, 2009
◦ Annual mammograms for women aged 40-49.
 Susan G. Komen for the Cure ®, the American Cancer Society and the
National Cancer Institute feel that the modest survival benefits of
mammography in women ages 40-49 outweigh the risks of false
positive results.
For more information on the
evidence for this recommendation,
click here.

All women ages 50 to 69 should have
annual mammograms.
◦ This guideline is based on scientific evidence from
randomized controlled trials done in the United States,
Canada and Europe. A 2009 study that combined the data
from seven randomized trials found that women aged 50 and
older who had regular mammography had a 23 percent lower
risk of dying from breast cancer than their peers who did not
[12].
◦ For women ages 50 to 69, the life-saving benefits of
mammography are clear.

Healthy women ages 70 and older continue
to get annual mammograms [18-19].
◦ Breast cancer risk increases with age, and mammography does
not appear to be less effective for women 70 and older.
At least every 3 years ages 20-39.
 Every year beginning at age 40.

◦ Susan G. Komen for the Cure® and the American Cancer Society have
same guidelines. USPTF and NCI make no recommendation.
Breast cancer self awareness- help patients
understand what is normal so they can identify
issues
 Encourage women to know what is normal for
them
 Learn more about signs that should not be
ignored here

Risk factor
Lobular carcinoma in situ
(LCIS) or atypical hyperplasia
Clinical breast exam
Every 6-12 months
Screening schedule
Mammogram
Every year
MRI and mammogram
Talk to your health care
provider
BRCA1 or BRCA2 carrier
or
first-degree relative of BRCA1
or BRCA2 carrier, but have
not been tested for these
genetic mutations
Strong family history of
breast or ovarian cancer (for
example, two or more firstdegree relatives with breast
cancer or two or more with
ovarian cancer)
Adapted from American Cancer Society
and National Comprehensive Cancer Network
materials [8,48].
Every year
Every 6-12 months
Every year
Every 6-12 months
Under age 25
Not recommended
Age 25 and older
Every year
Not recommended
Every year
Under age 25
Not recommended
Not recommended
Age 25 and over
Every year starting at age Every year starting at age
5-10 years prior to the
5-10 years prior to the
youngest breast cancer
youngest breast cancer
case in the family
case in the family
Risk factor
Clinical breast exam
Radiation treatment to the
chest between ages 10 and
30 years
Every year
Every 6-12 months
Screening schedule
Mammogram
MRI and mammogram
Under age 25
Not recommended
Not recommended
Age 25 and over
Every year starting 8-10
Talk to your health care
years after radiation
provider
treatment or at age 25
(whichever age occurs
last)
Every year starting at age Every year starting at age
30
30
Women with Li-Fraumeni,
Cowden or Bannayan-RileyRuvalcaba syndrome and
their first-degree relatives
Every 6-12 months
Personal history of cancer
(including DCIS)
Women with dense breast
tissue
Every year
Every year
Every year
Every year
Adapted from American Cancer Society
and National Comprehensive Cancer Network
materials [8,48].
Talk to your health care
provider
Talk to your health care
provider
Average risk
<40
BSA
CBE

Mammogram

Beginning at age
20, every 3 years
40-49
50-69
>70
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





annual
annual
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
annual

annual
annual
High risk
◦
◦
◦
◦
See tables for specific risk factor information
CBE 6 months to annually depending on risk factor
Mammograms starting at 25 for some risk factors
MRI and mammograms starting at 30 for some risk factors
annual
General Recommendations
 High Risk Groups
 High Risk Recommendations
 Risk Factors Table

http://ww5.komen.org/BreastCancer/EarlyD
etectionReferences.html
 Summary of research on mammography in
women 50-69

Mammogram/CBE Reminder
 NCI Breast Cancer Risk Assesment

◦ These recommendations differed from previous statements recommending screening in
women 40 and older. Due to the exclusion of many studies because of what were
determined to be study design flaws, the USPSTF found that there was not sufficient
evidence of benefits to recommend screening in women 40-49 in context of the potential
harms.
◦ Because breast cancer false positive results are more common in women under 50, some
argue for a different screening approach in women 40-49 than in those over 50. The USPSTF
suggests that women 40-49 consider their individual risk of developing breast cancer before
making a decision about screening mammography.They further suggest that those women at
increased risk should strongly consider regular mammography screening. Women at lower
risk, who wish to initiate screening in their 40s should recognize that the benefits of
screening are less than in older women.
◦
The USPSTF also suggests that screening every other year is likely to be as effective as
annual screening, and that this approach would decrease false positives. Biennial screening is
already practiced in many countries. Different organizations, based on a review of the same
data, may recommend either yearly or every other year screening for women at average risk
of breast cancer between the ages of 40-75.
◦
From the Susan G. Komen for the Cure Scientific Advisory Board Regarding U.S.
Preventive Services Task Force (USPSTF) Recommendations on Breast Screening
(November 16, 2009)
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◦ Compared to older women, women ages 40 to 49 have a lower risk of breast cancer. Because
of this, there are fewer benefits of screening mammography and some drawbacks. There is a
high rate of false positive results in this age group. A false positive result occurs when a
screening test shows that there is cancer when in fact, cancer is not present. Because so few
breast cancers occur in young women, younger women who are screened with mammography
are more likely than older women to have a false positive result. This means they will be told
that they have an abnormality and will undergo follow-up tests (such as further
mammograms, ultrasounds or even biopsies) only to find that they do not have breast cancer.
◦ In younger women, the denser breast tissue can make abnormalities harder to find with
mammography[15]. Cancers in younger women tend to grow more quickly, so biennial
mammograms may be less likely to discover cancers while most treatable in the earlier stages
[15].Thus, mammography offers fewer benefits to younger women than older women.
◦ A meta-analysis that combined data from eight randomized controlled trials found that
women 40 to 49 who had regular mammograms had a 15 percent lower risk of dying from
breast cancer [13]. However, other studies have not found a benefit for women in this age
group [12-14].
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
Signs that should not be ignored:
◦ Lumps, hard knot or thickening in any part of the breast
◦ Swelling, warmth, redness or darkening
◦ Change in the size or shape of the breast
◦ Dimpling or puckering of skin
◦ Itchy, scaly sore or rash on the nipple
◦ Pulling in of the nipple or other parts
◦ Nipple discharge that starts suddenly
◦ New pain in one spot that does not go away
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