Achieve Mastery of Medical Concepts

Study for medical school and boards with Lecturio

Breast Cancer Screening (Clinical)

Breast cancer is the most common cancer in women and the 2nd-leading cause of cancer-related deaths in women in the United States. Early detection and improved pathology-specific treatments have resulted in a decrease in death rates. Several organizations provide recommendations regarding screening for specific age and risk groups. Screenings include breast examination, mammography, magnetic resonance imaging (MRI), and ultrasound (US).

Last updated: Mar 4, 2024

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Overview

Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer

Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer is a disease characterized by malignant transformation Transformation Change brought about to an organism’s genetic composition by unidirectional transfer (transfection; transduction, genetic; conjugation, genetic, etc.) and incorporation of foreign DNA into prokaryotic or eukaryotic cells by recombination of part or all of that DNA into the cell’s genome. Bacteriology of the epithelial cells of the breast.

Epidemiology[4,5,8]

  • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer is the most common cancer in women worldwide.
  • Accounts for 29% of all malignant diseases among women in the United States
  • Incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency: 125 cases per 100,000 women
  • Risk increases with age, with 90% of cases occurring in women > 40 years of age
  • Male breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer accounts for < 1% of total cases.
  • An important cause of death in women:
    • United States: the 2nd-leading cause of cancer-related deaths
    • Developing countries: the leading cause of cancer-related deaths
  • Early detection and improved treatments have reduced death rates.

Overview of screening Screening Preoperative Care process[4,12]

  • Goal of screening Screening Preoperative Care: detect preclinical disease in healthy, asymptomatic patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship
  • Best for:
    • Situations in which early detection and treatment reduce mortality Mortality All deaths reported in a given population. Measures of Health Status as compared with later diagnosis and treatment
    • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship most likely to develop the disease
  • Process:
    • Assess a patient’s risk for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
    • Baseline risk determines the best methods and frequencies for screening Screening Preoperative Care.
    • Perform screening Screening Preoperative Care tests.
    • Follow-up abnormal screening Screening Preoperative Care test results with further testing based on initial results

Risk factors for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer[4]

  • Family history Family History Adult Health Maintenance:
    • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer in 1st- or 2nd-degree relatives (mother, grandmother, sister)
    • Ashkenazi Jewish descent
  • Hormonal influences:
    • Long hormone exposure due to:
      • Early menarche Menarche The first menstrual cycle marked by the initiation of menstruation. Menstrual Cycle 
      • Late menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause
      • Higher age at 1st delivery (> 30 years of age)
      • Nulliparity
      • Hormone replacement therapy Hormone Replacement Therapy Hormone replacement therapy (HRT) is used to treat symptoms associated with female menopause and in combination to suppress ovulation. Risks and side effects include uterine bleeding, predisposition to cancer, breast tenderness, hyperpigmentation, migraine headaches, hypertension, bloating, and mood changes. Noncontraceptive Estrogen and Progestins after menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause (> 5 years)
    • Note: Breastfeeding Breastfeeding Breastfeeding is often the primary source of nutrition for the newborn. During pregnancy, hormonal stimulation causes the number and size of mammary glands in the breast to significantly increase. After delivery, prolactin stimulates milk production, while oxytocin stimulates milk expulsion through the lactiferous ducts, where it is sucked out through the nipple by the infant. Breastfeeding for at least 6 months decreases the risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer.
  • Genetic mutations Genetic Mutations Carcinogenesis (examples):
    • BRCA1 (on chromosome Chromosome In a prokaryotic cell or in the nucleus of a eukaryotic cell, a structure consisting of or containing DNA which carries the genetic information essential to the cell. Basic Terms of Genetics 17q)
    • BRCA2 (on chromosome Chromosome In a prokaryotic cell or in the nucleus of a eukaryotic cell, a structure consisting of or containing DNA which carries the genetic information essential to the cell. Basic Terms of Genetics 13q)
    • p53 (on chromosome Chromosome In a prokaryotic cell or in the nucleus of a eukaryotic cell, a structure consisting of or containing DNA which carries the genetic information essential to the cell. Basic Terms of Genetics 17)
  • Increasing age
  • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer on the contralateral side
  • Prior breast biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma with:
  • Dense breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy
  • History of chest radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma as a young woman (10‒30 years old)
  • Lifestyle factors that increase the risk:
    • High-fat diet
    • Obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity (especially after menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause)
    • Heavy alcohol use
    • Tobacco

Mnemonic:

BReast- CA CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)ncer 1 and 2: BRCA1 and BRCA2 are the mutated genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure in breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer.

Initial risk assessment Risk assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. Preoperative Care[4,12]

Details of the patient’s medical and personal history are needed to determine their risk:

  • Personal and family history Family History Adult Health Maintenance of breast, ovarian, tubal, or peritoneal cancer
  • Ancestry (associated with BRCA1 and BRCA2)
  • Known carrier Carrier Vaccination of a gene mutation Gene Mutation Myotonic Dystrophies for breast or ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer:
    • If not known, determine the need for genetic testing Genetic Testing Detection of a mutation; genotype; karyotype; or specific alleles associated with genetic traits, heritable diseases, or predisposition to a disease, or that may lead to the disease in descendants. It includes prenatal genetic testing. Myotonic Dystrophies based on risk factors.
    • Genetic testing Genetic Testing Detection of a mutation; genotype; karyotype; or specific alleles associated with genetic traits, heritable diseases, or predisposition to a disease, or that may lead to the disease in descendants. It includes prenatal genetic testing. Myotonic Dystrophies for hereditary breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer is recommended when specific criteria are met MET Preoperative Care (criteria vary slightly according to organization (see below)).
  • Mammographic breast density
  • High-risk lesion on a previous breast biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma
  • History of chest radiotherapy (age 10–30 years)

A patient’s risk for developing breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer can be classified as:

  • Average:
    • Have none of the above risk factors (most patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship)
    • Lifetime risk < 15%
  • Moderate:
    • Most women with a family history Family History Adult Health Maintenance of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer in a 1st-degree relative, but no known genetic syndrome
    • Lifetime risk 15%‒20%
  • High:
    • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with:
      • A known genetic predisposition
      • Personal history of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
      • History of chest irradiation between the ages of 10 and 30 years
    • Lifetime risk > 20%

Determining the need for genetic evaluation:

Criteria from the National Comprehensive Cancer Network (NCCN),[10] the American College of Obstetricians and Gynecologists (ACOG), and the Society of Gynecologic Oncologists (SGO)[9] for genetic evaluation of hereditary breast and ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer include:

  • Individuals who are diagnosed with breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer OR who have a 1st-degree (or several close) relatives diagnosed with any of the following:
    • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at ≤ 45 years of age
    • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at ≤ 50 years of age with unknown family history Family History Adult Health Maintenance
    • Triple-negative (ER‒, PR‒, HER2 HER2 A cell surface protein-tyrosine kinase receptor that is overexpressed in a variety of adenocarcinomas. It has extensive homology to and heterodimerizes with the EGF receptor, the ERBB-3 receptor, and the ERBB-4 receptor. Activation of the erbB-2 receptor occurs through heterodimer formation with a ligand-bound erbB receptor family member. Targeted and Other Nontraditional Antineoplastic Therapy‒) breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at ≤ 60 years of age
    • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at any age with Ashkenazi Jewish ancestry
    • ≥ 2 primary breast cancers in the same individual
    • Epithelial ovarian, tubal, or peritoneal cancer (ever)
    • Pancreatic cancer
    • Metastatic prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. cancer
  • Individual unaffected by cancer but with 1 of the following factors that increase likelihood of an inherited risk of breast, tubal, ovarian, or peritoneal cancer:
    • Close relatives with criteria listed above
    • Close relative carrying a known BRCA1 or BRCA2 mutation Mutation Genetic mutations are errors in DNA that can cause protein misfolding and dysfunction. There are various types of mutations, including chromosomal, point, frameshift, and expansion mutations. Types of Mutations
    • Close relative with male breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
  • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at any age PLUS 1 of the following:
    • ≥ 1 close relative with:
      • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at ≤ 50 years of age
      • Epithelial ovarian, tubal, or peritoneal cancer (ever)
      • Pancreatic cancer
      • Male breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer or high-grade (Gleason score ≥ 7) /metastatic prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. cancer
    • ≥ 2 close relatives with breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer at any age
  • Note: Close relatives are defined as 1st degree (parent, sibling, children), 2nd degree (grandparent, grandchild, aunt/uncle, niece/nephew, half-sibling), or 3rd degree (1st cousin, great-grandparent, great-grandchild).

Familial risk assessment Risk assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. Preoperative Care tools:

  • Help determine need for in-depth genetic counseling Genetic Counseling An educational process that provides information and advice to individuals or families about a genetic condition that may affect them. The purpose is to help individuals make informed decisions about marriage, reproduction, and other health management issues based on information about the genetic disease, the available diagnostic tests, and management programs. Psychosocial support is usually offered. Myotonic Dystrophies for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with personal history or family history Family History Adult Health Maintenance of breast, ovarian, tubal, or peritoneal cancer 
  • Tools include:[2]
    • Ontario Family History Family History Adult Health Maintenance Risk Assessment Risk assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. Preoperative Care Tool
    • Manchester Scoring System
    • Referral screening Screening Preoperative Care tool
    • Pedigree Pedigree The record of descent or ancestry, particularly of a particular condition or trait, indicating individual family members, their relationships, and their status with respect to the trait or condition. Basic Terms of Genetics assessment tool
    • 7-Question Family History Family History Adult Health Maintenance Screening Screening Preoperative Care Tool
    • International Breast Cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer Intervention Study (IBIS) model (also known as Tyrer-Cuzick model)[3]
      • Recommended by the American Society of Breast Surgeons (ASBrS)
      • Takes into account family and personal history of cancer, breast density, and biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma results
      • IBIS web tool
    • BRCAPRO (calculates the probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability of carrying BRCA1 and/or BRCA2 mutation Mutation Genetic mutations are errors in DNA that can cause protein misfolding and dysfunction. There are various types of mutations, including chromosomal, point, frameshift, and expansion mutations. Types of Mutations)
  • Positive results should lead to genetic counseling Genetic Counseling An educational process that provides information and advice to individuals or families about a genetic condition that may affect them. The purpose is to help individuals make informed decisions about marriage, reproduction, and other health management issues based on information about the genetic disease, the available diagnostic tests, and management programs. Psychosocial support is usually offered. Myotonic Dystrophies and potentially genetic testing Genetic Testing Detection of a mutation; genotype; karyotype; or specific alleles associated with genetic traits, heritable diseases, or predisposition to a disease, or that may lead to the disease in descendants. It includes prenatal genetic testing. Myotonic Dystrophies.
  • Genetic counseling Genetic Counseling An educational process that provides information and advice to individuals or families about a genetic condition that may affect them. The purpose is to help individuals make informed decisions about marriage, reproduction, and other health management issues based on information about the genetic disease, the available diagnostic tests, and management programs. Psychosocial support is usually offered. Myotonic Dystrophies and testing are not recommended for women with no personal or family history Family History Adult Health Maintenance or ancestry associated with BRCA1 or BRCA2.

Risk prediction models[3,4]

Prediction models calculating the risk of developing breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer (and in some, gynecologic cancer):

  • Breast Cancer Risk Assessment Tool Breast Cancer Risk Assessment Tool Breast Cancer Screening ( Gail model GAIL model Breast Cancer Screening): 
    • The most commonly used risk model
    • Indicated for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with no personal or strong family history Family History Adult Health Maintenance of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer (including ductal or lobular carcinoma in situ)
    • Takes into account age, ethnicity, age at menarche Menarche The first menstrual cycle marked by the initiation of menstruation. Menstrual Cycle, parity Parity The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. Pregnancy: Diagnosis, Physiology, and Care, and family history Family History Adult Health Maintenance of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
    • Less precise for older women
    • Cannot be used in certain subgroups (such as patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with genetic mutations Genetic Mutations Carcinogenesis, e.g., BRCA1 or BRCA2 mutations)
    • Gail model calculator
  • Other validated assessment tools:[4]
    • CanRisk Web Tool (previously known as BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm)):
      • From the given family history Family History Adult Health Maintenance, the tool calculates the risks of breast or ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer in women. 
      • Also used to calculate the probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability of being BRCA1 or BRCA2 carriers Carriers The Cell: Cell Membrane
      • CanRisk Web Tool 
    • Claus model: uses age at diagnosis of 1st- and 2nd-degree relatives (with a history of breast and ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer) to estimate the lifetime risk for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer 

Strategies for Screening

Breast examination Breast examination Physical examination of the breasts is important both in the evaluation of a breast complaint and screening for asymptomatic breast pathology such as a breast mass. The examination involves inspection of the breasts to look for asymmetry or skin/nipple changes, as well as palpation of the breasts, nipples, and axilla. Coupled with medical history, the outcome of a breast examination can be normal, lead to a clinical diagnosis (e.g., infection), or require additional diagnostic evaluation. Examination of the Breast

  • Self-examination:[4]
    • The regular Regular Insulin, repetitive inspection Inspection Dermatologic Examination of one’s own breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy for the purpose of detecting breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
    • Generally discouraged
    • Can lead to unnecessary procedures (e.g., mammograms and biopsies)
    • ACOG encourages teaching women “breast awareness” over self-exams[4]
      • Breast awareness: A woman’s awareness of the normal appearance and feel of her breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy
      • Women should be educated about signs and symptoms of potential cancer, including a new mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast, nipple Nipple The conic organs which usually give outlet to milk from the mammary glands. Examination of the Breast discharge, redness Redness Inflammation, or pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways.
      • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship should notify their healthcare provider if they notice a change.
  • Clinical examination:[1,36]
    • A clinical breast exam performed by a healthcare provider
    • Generally not recommended as a screening Screening Preoperative Care exam for asymptomatic average-risk women (some societies note it may be used as an adjunct only)
    • Utilized in the case of:
      • Women with a high risk (initial age differs depending on risk factors)
      • Any breast complaints or abnormalities
      • Low-resource settings
  • Localizing breast lesions:
    • If there is a vague or large area, then the affected breast quadrant may be noted.
    • If there is a focal lesion, then the lesion will be localized by the clock face position and distance from the nipple Nipple The conic organs which usually give outlet to milk from the mammary glands. Examination of the Breast.

Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening[3,7,13]

Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening is the most effective method of detecting early breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer, consistently demonstrating a 20%–40% decrease in mortality Mortality All deaths reported in a given population. Measures of Health Status among screened women:

  • High false-negative rate:
  • Types:
  • Screening Screening Preoperative Care versus diagnostic mammography Mammography Radiographic examination of the breast. Breast Cancer Screening:[13]
    • Screening Screening Preoperative Care mammography Mammography Radiographic examination of the breast. Breast Cancer Screening:
      • Performed on a woman with no symptoms or signs of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
      • Two standard views (+/– additional views) of each breast are obtained.
    • Diagnostic mammography Mammography Radiographic examination of the breast. Breast Cancer Screening:
      • A study providing more detailed images; views are tailored to the abnormality being evaluated. 
      • Performed on a woman who has a breast lesion suspicious for cancer either on clinical grounds or by findings on a screening Screening Preoperative Care mammogram Mammogram Fibrocystic Change
  • Single versus double reading:[7,13]
    • Single reading: Images are reviewed by a single radiologist (typical in the US).
    • Double reading: Images are reviewed by 2 radiologists, either independently or together as a consensus (standard in much of Europe).
    • The European Commission prefers double reading plus AI.[7]
  • Abnormal findings suggestive of malignancy Malignancy Hemothorax:[13]
    • Masses (especially when they appear spiculated)
    • Calcifications, especially:
      • Grouped microcalcifications
      • Linear or linear branching microcalcifications
      • Pleomorphic Pleomorphic Bacteroides calcifications
    • Asymmetries
    • Architectural distortion Distortion Defense Mechanisms
  • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with breast implants:
    • Radiopaque Radiopaque An object of high density that blocks X-rays (looks white) X-rays content makes mammography Mammography Radiographic examination of the breast. Breast Cancer Screening difficult.
    • Involves 4 views (instead of the usual 2) per breast

Magnetic resonance imaging (MRI)[11]

  • Indicated as supplementary screening Screening Preoperative Care along with mammography Mammography Radiographic examination of the breast. Breast Cancer Screening in women with a high risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer:
    • BRCA1 or BRCA2 mutations
    • Strong family histories of breast and/or ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer
    • History of chest irradiation between the ages of 10 and 30
  • May be appropriate in women at intermediate risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer:[11]
  • Used to follow up an abnormal or inconclusive mammogram Mammogram Fibrocystic Change result
  • Higher false positive False positive An FP test result indicates that a person has the disease when they do not. Epidemiological Values of Diagnostic Tests rates in women with dense breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy, leading to unneeded biopsies
  • Despite the increased sensitivity for malignancy Malignancy Hemothorax, there is no evidence of a decreased mortality Mortality All deaths reported in a given population. Measures of Health Status benefit.
Mammography and breast mri

Mammography and breast MRI
Image A shows mammography of the left breast in a BRCA1 gene mutation carrier. Note the extremely dense breast tissue.
Image B demonstrates an MRI with an enhancing mass (arrow) in the upper left breast that was occult on the mammogram.

Image: “MRI for breast cancer: Current indications” by Ojeda-Fournier H, Comstock CE. License: CC BY 2.0.

Ultrasound (US)[11,13]

  • Not routinely used for screening Screening Preoperative Care due to a high false-positive rate
  • Primarily used for:
  • Can be considered as an adjunct in patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with dense breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy

BI-RADS categories[13,14]

The Breast Imaging Reporting and Data System The Breast Imaging Reporting And Data System Breast Cancer Screening (BI-RADS):

  • A categorization Categorization Types of Variables system to help determine the risk of malignancy Malignancy Hemothorax based on the findings of imaging studies (e.g., mammography Mammography Radiographic examination of the breast. Breast Cancer Screening, ultrasonography, or MRI)
  • Provides a category from 0 to 6 that is associated with specific management recommendations
  • Standardizes imaging reports
  • Components of the BI-RADs report include:
    • Indication for the study
    • Prior images reviewed
    • Assessment of breast density:
      • 1: Breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy are almost entirely fatty
      • 2: Scattered areas of fibroglandular density
      • 3: Heterogeneously dense breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy, which may obscure small masses
      • 4: Extremely dense breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy, which lowers the sensitivity of mammography Mammography Radiographic examination of the breast. Breast Cancer Screening
    • Description of abnormalities
    • Summary, including the final BI-RADs assessment category (0‒6)
Table: Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening findings and recommendations
Category Assessment Follow-upa
BI-RADS 0 Incomplete assessment Additional mammographic views or ultrasonographic follow-up needed
BI-RADS 1 Negative Continue with routine screening Screening Preoperative Care.
BI-RADS 2 Benign Benign Fibroadenoma findings Continue with routine screening Screening Preoperative Care.
BI-RADS 3 Probably benign Benign Fibroadenoma findings Diagnostic mammography Mammography Radiographic examination of the breast. Breast Cancer Screening and/or ultrasonography in 6 months
BI-RADS 4 Suspicious abnormality Biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma should be considered
BI-RADS 5 Highly suggestive of malignancy Malignancy Hemothorax Biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma should be performed.
BI-RADS 6 Biopsy-proven malignancy Malignancy Hemothorax Management for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
aFollow-up guidelines listed here are for asymptomatic individuals who underwent routine screening mammography examinations. Follow-up can differ when imaging is performed in symptomatic individuals (e.g., patient with a breast mass).

Note: A negative report should not rule out malignancy if there is a high clinical suspicion. Consider follow-up with ultrasonography.

Screening for Average- and Moderate-Risk Individuals

Average risk

Society and government-sponsored guidelines differ in:

Understanding guideline differences

  • The primary reason for the variance in recommendation is that the societies and organizations weigh benefits and harms slightly differently from one another. 
  • This, however, can be very confusing for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship (and providers), so counseling women in order to allow for shared decision-making is typically encouraged.
Table: Lifetime benefits and harms of annual versus biennial screening Screening Preoperative Care mammography Mammography Radiographic examination of the breast. Breast Cancer Screening (per 1000 women screened)[4]
Variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables With annual screening Screening Preoperative Care for those 50‒74 years of age With biennial screening Screening Preoperative Care for those 50‒74 years of age
Fewer breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer deaths 9 7
Life-years gained 145 122
False positive False positive An FP test result indicates that a person has the disease when they do not. Epidemiological Values of Diagnostic Tests test results 1,798 953
Unnecessary breast biopsies 228 146
Overdiagnosis of breast tumors 25 19
Overdiagnosis refers to breast cancers identified on screening that would not have been a threat to a patient’s health during her lifetime.[1]
Table: Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer screening Screening Preoperative Care guidelines for average-risk individuals
Organization Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening Clinical breast examination Breast examination Physical examination of the breasts is important both in the evaluation of a breast complaint and screening for asymptomatic breast pathology such as a breast mass. The examination involves inspection of the breasts to look for asymmetry or skin/nipple changes, as well as palpation of the breasts, nipples, and axilla. Coupled with medical history, the outcome of a breast examination can be normal, lead to a clinical diagnosis (e.g., infection), or require additional diagnostic evaluation. Examination of the Breast
USPSTF[1,27]
  • Ages 40–49: individualizea,b
  • Ages 50–74: every 2 years
  • Ages > 75: insufficient evidence
Insufficient evidence
ACP[26]
  • Ages 40–49: individualizea
  • Ages 50–74: every 2 years
  • Ages ≥ 75: Discontinue screening Screening Preoperative Care if life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids is < 10 years.
Not recommended
ACS[5,6]
  • May offer at age 40; start at age 45.
  • Ages 45–54: annually
  • Ages 55 and above: every 1–2 years
  • Continue if life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids is ≥ 10 years.
Not recommended

Supports breast self-awareness.
American Society of Breast Surgeons[3]
  • Ages ≥ 40: annually
  • Preferred method: DBT
Not recommended
ACOG[4]
  • May offer at age 40.
  • Start no later than age 50: every 1–2 years.
  • Ages > 75: Assess health, longevity, and discontinuation options.
May be offered:

  • Ages 29–39: every 1–3 years
  • Ages ≥ 40: annually


Supports breast self-awareness.
NCCN[10]
  • Ages ≥ 40: annually
  • Ages 25–39: every 1–3 years
  • Ages ≥ 40: annually
European Commission[7] Not recommended
WHO[9]
  • Ages 50–69 years: every 2 years
  • Ages 40–49 and 70–75: screening Screening Preoperative Care programs only in well-resourced settings in the context of research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest
Recommended in low-resource settings with weak health systems Health systems The complexity of health systems and the delivery of healthcare has resulted in the growing field of health systems science, which has now joined basic and clinical sciences as the 3rd pillar of medical education. Health systems science allows for an understanding of the framework in which care providers practice, and in comprehension of the interconnected components of care delivery. Healthcare System
aDiscuss breast cancer screening, risks, benefits, and potential for unnecessary procedures. For patients who choose to initiate screening, mammography is performed every 1–2 years.
bThe USPSTF has issued a draft recommendation statement recommending screening to begin at age 40 and continue every other year. More research is required regarding additional screening with ultrasound or MRI for women with dense breasts. Public comment and finalized recommendation are pending.
ACOG: American College of Obstetricians and Gynecologists
ACP: American College of Physicians
ACS: American Cancer Society
DBT: digital breast tomosynthesis (i.e., 3D mammography)
NCCN: National Comprehensive Cancer Network
USPSTF: U.S. Preventive Services Task Force

Moderate risk[12]

Screening for High-Risk Individuals

High-risk individuals are defined by the ASBrS and the NCCN as people with:[3]

  • A BRCA gene mutation Gene Mutation Myotonic Dystrophies (or other hereditary mutations known to increase the risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer)
  • A very strong family history Family History Adult Health Maintenance of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer and who have not undergone genetic testing Genetic Testing Detection of a mutation; genotype; karyotype; or specific alleles associated with genetic traits, heritable diseases, or predisposition to a disease, or that may lead to the disease in descendants. It includes prenatal genetic testing. Myotonic Dystrophies
  • A history of chest irradiation between ages 10 and 30
  • > 20% estimated lifetime risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer based on risk assessment Risk assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. Preoperative Care tools (e.g., IBIS/Tyrer-Cuzick, BRCAPro, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).)

Screening Screening Preoperative Care recommendations[9]

Risk reduction[15,20]

Nonsurgical:

  • Target modifiable risk factors:
  • Chemoprevention:[15,20]
    • USPSTF:[15] Risk-reducing medications are recommended for high-risk women ≥ 35 years of age (for a total of 5 years).
    • Considered in women at a high risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
    • Selective estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors modulators ( SERMs SERMs A structurally diverse group of compounds distinguished from estrogens by their ability to bind and activate estrogen receptors but act as either an agonist or antagonist depending on the tissue type and hormonal milieu. They are classified as either first generation because they demonstrate estrogen agonist properties in the endometrium or second generation based on their patterns of tissue specificity. Antiestrogens):
      • Tamoxifen Tamoxifen One of the selective estrogen receptor modulators with tissue-specific activities. Tamoxifen acts as an anti-estrogen (inhibiting agent) in the mammary tissue, but as an estrogen (stimulating agent) in cholesterol metabolism, bone density, and cell proliferation in the endometrium. Antiestrogens 20 mg by mouth once daily for 5 years
      • Raloxifene Raloxifene A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. Other Antiresorptive Drugs 60 mg by mouth once daily for 5 years (or longer in women with osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis)
      • Indicated for BRCA2 carriers Carriers The Cell: Cell Membrane who opt out of prophylactic mastectomy Mastectomy Surgical procedure to remove one or both breasts. Fat Necrosis of the Breast 
      • Less effective than risk-reducing surgery
      • Used in pre- or postmenopausal women
      • Choosing a SERM: Raloxifene Raloxifene A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. Other Antiresorptive Drugs results in a smaller reduction of new breast cancers as compared with tamoxifen Tamoxifen One of the selective estrogen receptor modulators with tissue-specific activities. Tamoxifen acts as an anti-estrogen (inhibiting agent) in the mammary tissue, but as an estrogen (stimulating agent) in cholesterol metabolism, bone density, and cell proliferation in the endometrium. Antiestrogens, but it has a lower risk of endometrial cancer Endometrial Cancer Endometrial carcinoma (EC) is the most common gynecologic malignancy in the developed world, and it has several histologic types. Endometrioid carcinoma (known as type 1 EC) typically develops from atypical endometrial hyperplasia, is hormonally responsive, and carries a favorable prognosis. Endometrial Hyperplasia and Endometrial Cancer and thrombosis Thrombosis Formation and development of a thrombus or blood clot in the blood vessel. Epidemic Typhus and is also a treatment for osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis.[20]
    • Aromatase Aromatase An enzyme that catalyzes the desaturation (aromatization) of the ring a of C19 androgens and converts them to C18 estrogens. In this process, the 19-methyl is removed. This enzyme is membrane-bound, located in the endoplasmic reticulum of estrogen-producing cells of ovaries, placenta, testes, adipose, and brain tissues. Aromatase is encoded by the cyp19 gene, and functions in complex with NADPH-ferrihemoprotein reductase in the cytochrome p450 system. Adipose Tissue: Histology inhibitor:
      • Anastrozole Anastrozole A nitrile and triazole derivative that acts as a selective nonsteroidal aromatase inhibitor. It is used in the treatment of estrogen nuclear receptor-positive breast cancer in postmenopausal women. Antiestrogens 1 mg once daily for 5 years
      • Off-label use for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer risk reduction
      • Used in postmenopausal women

Surgical: prophylactic mastectomy Mastectomy Surgical procedure to remove one or both breasts. Fat Necrosis of the Breast:

Women should be counseled on the potential morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status of surgical procedures ( surgical menopause Surgical Menopause Menopause, libido, body image).

  • Indications:
  • Does not completely eliminate the risk of cancer
  • May be done in conjunction with salpingo-oophorectomy to reduce ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer risk

Screening for Special Populations

Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with dense breast tissue[3,7]

  • The same approach to screening Screening Preoperative Care is recommended.
  • Digital mammography Digital Mammography Breast Cancer Screening is preferred over film.
  • ASBrS and the European Commission both recommend DBT for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with dense breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy.[3,7]
  • If there are no additional risk factors, no supplemental screening Screening Preoperative Care is recommended.
  • MRI or US may be used as an adjunct in moderate- or high-risk patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship.

Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship[16]

  • Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening screening Screening Preoperative Care is typically appropriate in the following patient populations:
    • Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria women (male-to-female) at high risk for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer who are 25‒30 years of age with past or current hormone use ≥ 5 years 
    • Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria men (female-to-male) with reduction mammoplasty or no chest surgery who are:
      • At high risk for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer and 25‒30 years of age 
      • At intermediate risk for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer and ≥ 30 years of age 
      • At average risk for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer and ≥ 40 years of age 
  • Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening may be appropriate in some of the following cases:
    • Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria women at high risk who are 25‒30 years of age with hormone use < 5 years
    • Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria women at average risk who are ≥ 40 years of age with past or current hormone use ≥ 5 years
  • Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening is typically not indicated for:
    • Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria women at average risk with hormone use < 5 years at any age.
    • Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria men with bilateral mastectomies at any age and any risk level

Male BRCA carriers Carriers The Cell: Cell Membrane[19,24]

Male BRCA carriers Carriers The Cell: Cell Membrane have a higher risk for breast, prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. , and pancreatic cancers:

  • Monthly breast self-examination starting at age 35
  • Annual clinical breast exam starting at age 35
  • Annual mammography Mammography Radiographic examination of the breast. Breast Cancer Screening can be considered in men with gynecomastia Gynecomastia Gynecomastia is a benign proliferation of male breast glandular ductal tissue, usually bilateral, caused by increased estrogen activity, decreased testosterone activity, or medications. The condition is common and physiological in neonates, adolescent boys, and elderly men. Gynecomastia or increased breast density (evidence is limited).
  • Prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. cancer screening Screening Preoperative Care starting at age 40 for BRCA2 carriers Carriers The Cell: Cell Membrane
  • Consideration of prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. screening Screening Preoperative Care starting at age 40 for BRCA1 carriers Carriers The Cell: Cell Membrane

References

  1. U.S. Preventive Services Task Force. (2016). Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 2016(164), 279–296. 
  2. U.S. Preventive Services Task Force. (2019). Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. JAMA, 322(7), 652–665.
  3. American Society of Breast Surgeons. (2019). Position statement on screening mammography. https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf
  4. American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology. (2017). Practice bulletin no. 179: breast cancer risk assessment and screening in average-risk women. Obstetrics and Gynecology, 130(1), e1‒e16. https://doi.org/10.1097/AOG.0000000000002158  
  5. Oeffinger, K. C., Fontham, E. T., Etzioni, R., Herzig, A., Michaelson, J. S., Shih, Y. C., Walter, L. C., Church, T. R., Flowers, C. R., LaMonte, S. J., Wolf, A. M., DeSantis, C., Lortet-Tieulent, J., Andrews, K., Manassaram-Baptiste, D., Saslow, D., Smith, R. A., Brawley, O. W., Wender, R., American Cancer Society. (2015). Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA, 314(15), 1599–1614. https://doi.org/10.1001/jama.2015.12783 
  6. American Cancer Society. (2020). American Cancer Society recommendations for the early detection of breast cancer. Retrieved December 10, 2022, from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
  7. European Commission Initiative on Breast Cancer. (2022). European guidelines on breast cancer screening and diagnosis. Retrieved September 27, 2022, from https://healthcare-quality.jrc.ec.europa.eu/ecibc/european-breast-cancer-guidelines 
  8. World Health Organization. (2014). WHO position paper on mammography screening. Retrieved September 27, 2022, from https://www.who.int/publications/i/item/who-position-paper-on-mammography-screening 
  9. American College of Obstetricians and Gynecologists Committee on Practice Bulletins‒Gynecology, & Society of Gynecologic Oncology Committee on Genetics. (2017). Practice bulletin no. 182: hereditary breast and ovarian cancer syndrome. Obstetrics and Gynecology 130(3), e110‒e126. 
  10. National Comprehensive Cancer Network. (2019). Genetic/familial high-risk assessment: breast and ovarian cancer. NCCN clinical practice guidelines in oncology, version 3.2019. Retrieved September 27, 2022, from https://www2.tri-kobe.org/nccn/guideline/gynecological/english/genetic_familial.pdf 
  11. American College of Radiology. (2017). ACR appropriateness criteria for breast cancer screening. Retrieved September 28, 2022, from https://acsearch.acr.org/docs/70910/Narrative/ 
  12. Elmore, J. G., Lee, C. I. (2020). Screening for breast cancer: strategies and recommendations. UpToDate. Retrieved December 14, 2020, from https://www.uptodate.com/contents/screening-for-breast-cancer-strategies-and-recommendations
  13. Venkataraman, S., Slanetz, P. J. (2020). Breast imaging for cancer screening: mammography and ultrasonography. UpToDate. Retrieved December 14, 2020, from https://www.uptodate.com/contents/breast-imaging-for-cancer-screening-mammography-and-ultrasonography
  14. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. (2015). Committee opinion no. 625: management of women with dense breasts diagnosed by mammography. Retrieved September 28, 2022, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/03/management-of-women-with-dense-breasts-diagnosed-by-mammography 
  15. U.S. Preventive Services Task Force. (2019). Final recommendation statement: breast cancer: medication use to reduce risk. Retrieved September 29, 2022, from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-medications-for-risk-reduction 
  16. American College of Radiology. (2017). ACR appropriateness criteria for transgender breast cancer screening. Retrieved September 28, 2022, from https://acsearch.acr.org/docs/3155692/Narrative/ 
  17. Elmore, J. G., Lee, C. I. (2020). Screening for breast cancer: evidence for effectiveness and harms. UpToDate. Retrieved December 14, 2020, from https://www.uptodate.com/contents/screening-for-breast-cancer-evidence-for-effectiveness-and-harms
  18. Freer, P .E., Slanetz, P. J. (2020). Breast density and screening for breast cancer. UpToDate. Retrieved December 14, 2020, from https://www.uptodate.com/contents/breast-density-and-screening-for-breast-cancer
  19. Isaacs, C., Peshkin, B. N. (2020). Cancer risks and management of BRCA1/2 carriers without cancer. UpToDate. Retrieved December 14, 2020, from https://www.uptodate.com/contents/cancer-risks-and-management-of-brca1-2-carriers-without-cancer
  20. Peshkin, B. N., Isaacs, C. (2020). Genetic testing and management of individuals at risk of hereditary breast and ovarian cancer syndromes. UpToDate. Retrieved December 14, 2020, from https://www.uptodate.com/contents/genetic-testing-and-management-of-individuals-at-risk-of-hereditary-breast-and-ovarian-cancer-syndromes
  21. Sharma, P., Chen, W. Y. (2020). Selective estrogen receptor modulators and aromatase inhibitors for breast cancer prevention. UpToDate. Retrieved December 15, 2020, from https://www.uptodate.com/contents/selective-estrogen-receptor-modulators-and-aromatase-inhibitors-for-breast-cancer-prevention
  22. Kosir, M. A. (2020). Breast cancer. MSD Manual Professional Version. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/breast-cancer
  23. Newton, E. V., Grethlein, S. J. (2020). Breast cancer screening. Medscape. https://emedicine.medscape.com/article/1945498-overview
  24. Ibrahim, M., Yadav, S., Ogunleye, F., Zakalik, D. (2018). Male BRCA mutation carriers: clinical characteristics and cancer spectrum. BMC Cancer, 18. https://doi.org/10.1186/s12885-018-4098-y
  25. Katzen, J., Dodelzon, K. (2018). A review of computer aided detection in mammography. Clinical Imaging, 52, 305–309. https://doi.org/10.1016/j.clinimag.2018.08.014
  26. Qaseem, A., et al. (2019). Screening for breast cancer in average-risk women: A guidance statement from the American College of Physicians. Annals of Internal Medicine, 170(8):547–560. https://www.acpjournals.org/doi/10.7326/m18-214
  27. U.S. Preventive Services Task Force (2023). Task force issues draft recommendation statement on screening for breast cancer. USPSTF Bulletin. Retrieved May 25, 2023, from https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/breast-cancer-screening-draft-rec-bulletin.pdf

Create your free account or log in to continue reading!

Sign up now and get free access to Lecturio with concept pages, medical videos, and questions for your medical education.

User Reviews

Details