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Introduction: When to screen? ◦ Komen’s Response Komen Recommendations: ◦ Mammography ◦ CBE ◦ BSA ◦ Highlighting at Risk Groups ◦ What to Do With High Risk Groups Overview 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 annual annual 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) Return to slide ◦ 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]. Return to slide 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 Return to slide