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TABLE 1. Screening Recommendations
U.S. PREVENTIVE SERVICES TASK FORCE 201613
AMERICAN CANCER SOCIETY 201514
AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS 201115
AMERICAN COLLEGE OF PHYSICIANS11
AMERICAN COLLEGE OF RADIOLOGY 2010 16
AMERICAN ACADEMY OF FAMILY PHYSICIANS 201617
Women aged 40
to 49 with average risk
The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place
a higher value on the potential benefit than the potential harms may choose to begin screening between 40 and
49 years
Women aged 40 t0 44 should have the choice to start annual screening mammograms if they wish to do so. The risks of screening as well as the potential benefits should be considered.
Women aged 45 to 49 years should get mammograms every year.
Screening mammography and clinical breast exams annually
Discuss benefits and harms with women in good health and order screening with mammography every two years if a woman requests it.
Screening with mammography annually
The decision to start screening mammography should be
an individual one. Women who place a higher value on the potential benefit than the potential harms may choose
to begin screening.
Women aged 50
to 74 with average risk
Biennial screening mammography is recommended
Women aged 50 to 54 years should get mammograms every year.
Screening mammography and clinical breast exams annually
Physicians
should encourage screening every two years in average-risk women
Screening with mammography annually
Biennial screening with mammography
the mammographic breast density should
extremely dense breast tissue might be a reason to have adjunctive imaging in spite of the increase in false positives.
Currently commercially available adjunctive imaging modalities are MRI and ultrasound. MRI increases the number of cancers found per 1,000 screens, but it “false positive” biopsies. It also requires intravenous injection of Gadolinium, which may accumulate in the brain. MRI is also very expensive. Ultrasound screening increases cancer detection modestly, three to four per 1,000 screens, and increases
Tomosynthesis, compared to 2D digital mammography, increases cancer detection by one to four per 1,000 screens, and
importantly, DECREASES recalls and
group is that they should have annual tomosynthesis and only have additional tomosynthesis.
validated commercial availability of another form of breast imaging which, like MRI, is a molecular functional rest, not just a morphologic test. Molecular Breast Imaging converts gamma-ray energy to electronic signals. The new centimeter tumors, an improvement over earlier versions. Single institution studies indicate that MBI may increase by eight per 1,000 screens the number of cancers found in women with extremely dense breasts. It does not involve Gadolinium, but it does require an injection
intravenously. The radiation dose is slightly higher than mammography. There may soon be direct biopsy capability.20
There is one other question that women should ask their PCP. What can I do to reduce my risk of breast cancer?
For women at very high levels of
Tyrer-Cuzick model, or women with deleterious mutations, there is solid evidence that Tamoxifen and Evista 21 and that bilateral 22 But this is a very small subset of women. These risk reduction modalities are not appropriate for the vast majority of women who will receive dense breast methods indicated for all of us, regardless of breast density or lifetime risk of breast cancer:
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Del Med J | March 2018 | Vol. 90 | No. 3
