Breast cancer screening: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 34: Line 34:
* At age 55 years, women should have mammogram every other year should continue as long as the women is in good health.
* At age 55 years, women should have mammogram every other year should continue as long as the women is in good health.
* Breast exams are no longer recommended.<ref>Breast cancer guidelines. American cancer society (2016). http://www.cancer.org/cancer/news/news/american-cancer-society-releases-new-breast-cancer-guidelines Accessed on March 8, 2016</ref>
* Breast exams are no longer recommended.<ref>Breast cancer guidelines. American cancer society (2016). http://www.cancer.org/cancer/news/news/american-cancer-society-releases-new-breast-cancer-guidelines Accessed on March 8, 2016</ref>
* Because of variation in life style, genes as well as the other risk factors of breast cancer, national studies in each country is warranted in order to precisely determine the cut of point for age of starting screening.


==U.S. Preventive Service Task Force (USPSTF) sreening for breast cancer==
==U.S. Preventive Service Task Force (USPSTF) sreening for breast cancer==

Revision as of 14:19, 15 March 2019



Resident
Survival
Guide

Breast Cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Breast cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT scan

MRI

Echocardiography or Ultrasound

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Breast cancer screening On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Breast cancer screening

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Breast cancer screening

CDC on Breast cancer screening

Breast cancer screening in the news

Blogs on Breast cancer screening

Directions to Hospitals Treating Breast cancer

Risk calculators and risk factors for Breast cancer screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]Jack Khouri, Mirdula Sharma, MBBS [3]

Overview

According to the the U.S. Preventive Service Task Force (USPSTF), screening for breast cancer by mammogram is recommended for women aged 50-74 years, twice a year.

Screening

Three tests are used by health care providers to screen for breast cancer:[1]

Mammogram

  • Mammography is the most common screening test for breast cancer. A mammogram is an x-ray of the breast. This test may find tumors that are too small to feel. Mammograms are less likely to find breast tumors in women younger than 50 years than in older women. This may be because younger women have denser breast tissue that appears white on a mammogram.
  • The following may affect whether a mammogram is able to detect (find) breast cancer:
  • Size of the tumor
  • How dense the is breast tissue?
  • The radiologist knowledge and expertness
  • Women aged 40 to 74 years who have screening mammograms have a lower chance of dying from breast cancer than women who do not have screening mammograms.

Clinical breast exam

  • A clinical breast exam is an exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual. It is not known if having clinical breast exams decreases the chance of dying from breast cancer.
  • Doing breast self-exams has not been shown to decrease the chance of dying from breast cancer.
  • The USPSTF recommends against teaching breast self-examination (BSE). There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

MRI

  • MRIs find breast cancer more often than mammograms do, but it is common for MRI results to appear abnormal even when there isn't any cancer. (False positive)

The New Recommendations

  • Women should begin yearly mammogram by the age of 45 years.
  • At age 55 years, women should have mammogram every other year should continue as long as the women is in good health.
  • Breast exams are no longer recommended.[2]
  • Because of variation in life style, genes as well as the other risk factors of breast cancer, national studies in each country is warranted in order to precisely determine the cut of point for age of starting screening.

U.S. Preventive Service Task Force (USPSTF) sreening for breast cancer

Breast cancer screening: summary of recommendations

Population Recommendation Grade

(please refer to the next table below)

Women, Age 50-74 Years The USPSTF recommends biennial screening mammography for women 50-74 years. B
Women, Before the Age of 50 Years The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. C
Women, 75 Years and Older The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older.

Go to the Clinical Considerations section for information on risk assessment and suggestions for practice regarding the I statement.

I
All Women The USPSTF recommends against teaching breast self-examination (BSE). D
Women, 40 Years and Older The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.

Go to the Clinical Considerations section for information on risk assessment and suggestions for practice regarding the I statement.

I
All Women The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

Go to the Clinical Considerations section for information on risk assessment and suggestions for practice regarding the I statement.

I

Grade definitions after July 2012

Grade Definition Suggestions for Practice
A The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service.
B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Offer or provide this service.
C The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Offer or provide this service for selected patients depending on individual circumstances.
D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service.
I The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

Level of certainty

Level of Certainty* Description
High The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by such factors as:
  • The number, size, or quality of individual studies.
  • Inconsistency of findings across individual studies.
  • Limited generalizability of findings to routine primary care practice.
  • Lack of coherence in the chain of evidence.As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
Low The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:
  • The limited number or size of studies.
  • Important flaws in study design or methods.
  • Inconsistency of findings across individual studies.
  • Gaps in the chain of evidence.
  • Findings not generalizable to routine primary care practice.
  • Lack of information on important health outcomes.More information may allow estimation of effects on health outcomes.

References

  1. Breast Cancer. National Cancer Institute (2015) http://www.cancer.gov/types/breast/patient/breast-screening-pdq#section/_13 Accessed on January 15 2016
  2. Breast cancer guidelines. American cancer society (2016). http://www.cancer.org/cancer/news/news/american-cancer-society-releases-new-breast-cancer-guidelines Accessed on March 8, 2016


Template:WikiDoc Sources