Putting Prevention into Practice

An Evidence-Based Approach

Screening for Breast Cancer

 


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Am Fam Physician. 2016 Jul 15;94(2):143-144.

Related U.S. Preventive Services Task Force Recommendation Statement: Screening for Breast Cancer: Recommendation Statement.

Author disclosure: No relevant financial affiliations.

Case Study

S.O. is a 47-year-old woman who presents to your office for a well-woman visit. She is healthy, takes no medications, and has no health concerns. She has never been diagnosed with breast cancer, nor have any of her first-degree relatives. Her digital mammography two years ago was negative, and she asks whether she should be screened again this year.

Case Study Questions

  1. According to the U.S. Preventive Services Task Force (USPSTF), which one of the following approaches to screening is appropriate for this patient?

    • A. There is insufficient evidence to assess the balance of benefits and harms of screening mammography for this patient.

    • B. Do not screen for breast cancer, because she has no symptoms.

    • C. Do not screen for breast cancer, because she is not at increased risk of the disease.

    • D. If the patient places a higher value on the potential benefit than the potential harms, she may choose to undergo screening mammography again.

    • E. Do not screen for breast cancer until she is 50 years of age, because at her current age, the harms outweigh the benefits.

  2. The patient decides to undergo screening mammography again, and her breast density is categorized as heterogeneously dense. (The mammography result is otherwise negative.) According to the USPSTF, which one of the following responses is appropriate for this patient?

    • A. Inform the patient that this is an incidental finding and has no bearing on her screening results.

    • B. Recommend adjunctive (i.e., follow-up) breast ultrasonography this year.

    • C. Recommend digital breast tomosynthesis (DBT) for future screening.

    • D. Recommend adjunctive breast magnetic resonance imaging this year.

    • E. Inform the patient that the evidence is unclear regarding her best screening strategy.

  3. Which of the following statements best reflect the epidemiology of

Author disclosure: No relevant financial affiliations.

SOURCES

U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279–296.

Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2016;164(4):244–255.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and the supporting documents on the USPSTF website ( http://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Putting Prevention into Practice published in AFP is available at http://www.aafp.org/afp/ppip.



 

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