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BREAST CANCER SCREENING GUIDELINES

BREAST CANCER SCREENING GUIDELINES. Nadra Moulayes DO Sovereign Medical Group St. Joseph’s Regional Medical Center Department of Surgery Division of Breast Surgery. Breast Cancer. The most common cancer among women in the United States.

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BREAST CANCER SCREENING GUIDELINES

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  1. BREAST CANCER SCREENING GUIDELINES Nadra Moulayes DO Sovereign Medical Group St. Joseph’s Regional Medical Center Department of Surgery Division of Breast Surgery

  2. Breast Cancer • The most common cancer among women in the United States. • Second leading cause of cancer-related death in women. • 2014: more than 230,000 women will be diagnosed with breast cancer; claiming ~ 40,000 lives. • Since 1990’s breast cancer mortality rates have been dropping (avg. 2-3% per year).

  3. Risk Assessment • Breast Cancer • 80% sporadic • 15% hereditary • 5% genetic mutation • Life time risk ↑ with age: • 30-40 1.5% • 40-50 2.8% • 50-60 3.4% • 60-70 3.1 % • Cumulative life-time risk for general population is ~11%.

  4. Risk Assessment • Age • Family History/gene mutation • Clinical Factors • Proliferative disease with atypia • Chest wall radiation at younger age • Dense breast • Reproductive Factors • Prolonged hormonal exposure • Obesity • Tobacco • Alcohol? • Diet?

  5. Risk Calculation model • Gail • Tyer Cusak • Claus • Myriad • <12% general population risk • 12-20% intermediate risk • ≥ 20% high risk

  6. Screening Mammography • Age 40-49 • Multiple studies have shown ~ 24% reduction in mortality risk. • USPSTF systemic review reported that mammography reduces breast cancer mortality by 15% with over-diagnosis ~1-10%informed/shared decision. • ACOG, ACS and NCCN: annual screening.

  7. Ages 50-69 • Multiple randomized trials: breast cancer mortality reduced up to 20%. • USPSTF: biennial screening • NCCN: annual screening

  8. Ages 70 years and older • USPSTF: • insufficient evidence of benefits. • Biennial screening until age of 74. • 75 years or older patient’s based. • Decision for screening is patient/practitioner based.

  9. Breast Ultrasound • Literature: • As high 37% of all cancers in women with dense breasts were detected only with breast ultrasound. • Supplemental US detected additional 4.2 cancers per 1000 women. • Now indicated for women with dense breast on mammography.

  10. Other Modalities • Breast Self-Examination (BSE): • USPSTF: recommend against BSE • ACS, NCCN & ACOG: encourage BSE • Clinical Breast Examination (CBE): • USPSTF: insufficient evidence for benefits in women 40 years of age & older. • NCCN: continues to recommend.

  11. Breast MRI • In average risk patients: • high false-positive rate & over-diagnosis. • Benefits vs harms not determined  not recommended for screening. • ACS & NCCN: annual MRI in addition to mammogram for high risk patients: • self/1st degree relative with known gene mutations. • Patient with hx. of chest wall radiation between 10-30 years of age. • Insufficient evidence: LCIS, ADH, dense breasts, personal hx. Of BC, or lifetime risk <20%.

  12. Reference • National Cancer Comprehensive Network Guidelines. Available @ www.nccn.org/professionals/physician_gls/f_guidelines.asp • U.S Preventive Service Task Force Recommendations. Available @ www.uspreventiveservicetaskforce.org • Nemec et al. How should we screen for breast cancer? Mammography, ultrasonography, MRI. Cleve Clin J Med 2007;74:897-904 • Kolv et al. Comparison of the performance of screening, physical exam and breast ultrasound and evaluation of factors that influence them: an analysis of 27,825 patients evaluation. Radiology 2002;225 (1)165-75

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