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Chapter: Obstetrics and Gynecology: Disorders of the Breast

Disorders of the Breast: Screening Guidelines

For the general population, breast cancer surveillance involves a combination of clinical breast examinations and radiographic imaging.

SCREENING GUIDELINES

 

For the general population, breast cancer surveillance involves a combination of clinical breast examinations and radiographic imaging. In 2002, the U.S. Preventative Service Task Force (USPSTF) found insufficient evidence for or against breast self-examinations (BSE). The American College of Obstetricians and Gynecologists (2003) con-tinues to support the practice of BSE, because of the potential ability to detect a palpable breast cancer. The value of clinical breast examination in detecting breast cancer has also been studied. Pooled data from multiple studies supports the use and effectiveness of clinical breast examination. Multiple reviews have supported the combination of clinical breast examination and mam-mography for breast cancer screening for women aged 50 to 69 years. ACOG supports the recommendations of the American Cancer Society, which calls for clinical breast examinations every 3 years for women aged 20 to 39, and annually thereafter

The value of mammography increases with age. TheUSPSTF found sufficient evidence to demonstrate that mammogram screening every 1 to 3 years significantly reduced mortality from breast cancer. Controversy exists over screening intervals in younger women, where the incidence of breast cancer remains low. ACOG and the USPSTF currently recommend that mammography be performed every 1 to 2 years between ages 40 and 49, and annually thereafter.

 

These screening standards do not apply to women with inherited genetic mutations placing them at increased risk for developing breast cancer. In this population, breastcancer occurs at a younger age and is missed by screening mammography nearly 50% of the time. Current recom-mendations for BRCA carriers includes monthly breast self-examinations beginning at ages 18 to 20, annual clin-ical breast exams, and screening mammograms beginning after age 25 (or 5–10 years before the age of diagnosis in the affected relative). MRI is recommended as a supple-ment to mammography, not a replacement.

 

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