#179 Breast Cancer Risk Assessment and Screening in Average-Risk Women Flashcards
What is the most commonly diagnosed cancer in women in the US?
Breast cancer
What is the second leading cause of cancer death in American women?
breast cancer
Breast cancer accounts for what % of all new cases of cancer diagnosed in women?
30%
In the US, what is a women’s lifetime risk of developing breast cancer?
12% (1 in 8)
What is the current 5-year survival rate in women diagnosed with breast cancer?
90%
What percentage of breast cancer cases occur in women?
More than 99%
True or false: most cases of invasive breast cancer occur in women with identifiable risk factors?
False
What are breast cancer risk factors?
Family hx of breast, ovarian, or other hereditary breast and ovarian syndrome-associated cancer; known deleterious gene mutation; prior breast biopsy with atypical hyperplasia or LCIS; early menarche; late menopause; nulliparity; prolonged interval between menarche and first pregnancy; menopausal hormone therapy with E&P (decreased risk with estrogen alone); not breastfeeding; increasing age; certain ethnicity (ashkenazi jew); higher BMI; alcohol consumption; smoking; dense breasts on mammogram; prior exposure to high-dose therapeutic chest irradiation in women 10-30yo (Hodgkin lymphoma, greatest risk ages 10-14)
What reproductive factors decrease the risk of breast cancer?
Increased parity and breastfeeding
How does mammogram perform in women who have dense breasts?
Reduced sensitivity
What are ACOGs recommendations regarding clinical breast examination?
May be offered every 1-3 years for women aged 25-39 and annually for women 40+
What are ACOGs recommendations regarding mammography initiation age?
Offer starting at age 40. Initiate at ages 40-49 after counseling if patient desires. Recommend by no later than 50yo, if not already initiated
What are ACOGs recommendations regarding mammography screening interval?
Annual or biennial
What are ACOGs recommendations regarding age to stop mammography?
Continue until age 75yo. beyond 75yo, shared decision making process that includes a decision of the woman’s health status and longevity
What are US Preventative Services Task Force recommendations regarding clinical breast examination?
Insufficient evidence to recommend for or against
What are US Preventative Services Task Force recommendations regarding mammography initiation age?
Recommend at age 50. Age 40-49: can start on individual basis
What are US Preventative Services Task Force recommendations regarding mammography screening interval?
Biennial
What are US Preventative Services Task Force recommendations regarding age to stop mammography?
Current evidence insufficient to assess the balance of benefits and harms of screening in women 75+
What are American Cancer Society recommendations regarding clinical breast examination?
Does not recommend
What are American Cancer Society recommendations regarding mammography initiation age?
Offer at ages 40-45. Recommend at age 45yo.
What are American Cancer Society recommendations regarding mammography screening interval?
Annual for women aged 40-54. Biennial with the option to continue annual screening for women 55+
What are American Cancer Society recommendations regarding age to stop mammography?
When life expectancy is less than 10 years
What are National Comprehensive Cancer Network recommendations regarding clinical breast examination?
Recommend every 1-3 years for women aged 25-39. Annually for 40+
What are National Comprehensive Cancer Network recommendations regarding mammography initiation age?
Recommend at age 40
What are National Comprehensive Cancer Network recommendations regarding mammography screening interval?
Annually
What are National Comprehensive Cancer Network recommendations regarding age to stop mammography screening?
When severe comorbidities limit life expectancy to 10 years or less
What is the 10-year cumulative false-positive rate of mammograms with annual vs biennial screening? What is the need for biopsy in these two populations?
61% with annual screening and 42% with biennial screening. 7% of women screened annually, 5% of women screened biennially
Are women with false-positive results on mammogram more or less likely to return for next screening mammogram?
Less likely
What is overdiagnosis (re: cancer and mammogram screening)?
Screening detects cancer that would not have progressed to symptomatic cancer if left undetected
What is overtreatment (re: cancer and mammogram screening)?
Initiation of treatment for an overdiagnosed cancer
What proportion of women will have breast cancer be overdiagnosed?
1 in 8 women diagnosed with breast cancer will be overdiagnosed.
What breast cancer risk assessment tools are available?
Gail, BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, International Breast Cancr Intervention Studies, Claus model
What is the goal of breast cancer risk assessmen?
Identify women who may benefit from genetic counseling, enhanced screening such as MRI, more frequent clinical breast exams, or risk-reduction strategies
What is breast self-awareness?
Defined as a woman’s awareness of the normal appearance and feel of her breasts. Does not include routine systematic examination of their breasts. Rather notice change or potential problem, pain, mass, new onset nipple discharge, redness
Is breast self-examination recommended in average-risk women?
No, d/t risk of harm from false-positive test results and lack of evidence of benefit
What percentage of breast cancer cases are detected by the women themselves in women 50+ and in women <50yo.
50% of cases in women 50+. 71% of cases in women <50
Does clinical breast examination improve patient outcomes?
No evidence to suggest improvement in patient outcomes
