Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.
The AAFP recommends that the decision to conduct screening mammography before age 50 should be individualized and take into account patient context including her risks as well as her values regarding specific benefits and harms. (2009)
(Grade: C recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
Breast Cancer
Breast Cancer, Mammography, Before age 50
Breast Cancer, Mammography, Women 50 and 74
Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.
The AAFP recommends biennial (every two years) screening mammography for women between ages 50 and 74. (2009)
(Grade B recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
The AAFP recommends biennial (every two years) screening mammography for women between ages 50 and 74. (2009)
(Grade B recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
Breast Cancer, Mammography, Women 75 years and older
Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.
The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women aged 75 years and older. (2009)
(Grade I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women aged 75 years and older. (2009)
(Grade I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
Breast Cancer, Self BSE
Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.
The AAFP recommends against clinicians teaching women Breast Self Examination (BSE). (2009)
(Grade D recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
The AAFP recommends against clinicians teaching women Breast Self Examination (BSE). (2009)
(Grade D recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
Breast Cancer, Clinical Breast Examination (CBE)
Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.
The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination (CBE) for women aged 40 years and older. (2009)
(Grade I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination (CBE) for women aged 40 years and older. (2009)
(Grade I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
Breast Cancer, Digital Mammography or MRI
Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.
The AAFP concludes that current evidence is insufficient to assess benefits and harms of either digital mammography or MRI instead of film screen mammography as screening modalities for breast cancer. (2009)
(Grade I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
The AAFP concludes that current evidence is insufficient to assess benefits and harms of either digital mammography or MRI instead of film screen mammography as screening modalities for breast cancer. (2009)
(Grade I recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
Breast Cancer, Prevention Medication
The AAFP recommends against routine use of tamoxifen or raloxifene for the primary prevention of breast cancer in women at low or average risk for breast cancer. (2002)
(Grade: D recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespre.htm#drec)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm#clinical)
(Grade: D recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespre.htm#drec)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm#clinical)
Breast Cancer, Prevention Medication
The AAFP recommends that clinicians discuss chemoprevention with women at high risk for breast cancer and at low risk for adverse effects chemoprevention. (2002)
(Grade: B recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespre.htm#drec
(Clinical Considerations: Clinicians should inform patients of the potential benefits and harms of chemoprevention: http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm#clinical
(Grade: B recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespre.htm#drec
(Clinical Considerations: Clinicians should inform patients of the potential benefits and harms of chemoprevention: http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm#clinical
Breast Cancer/BRCA Mutation Testing
The AAFP recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. (2005)
(Grade: B recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm
(Grade: B recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm
Breast Cancer/BRCA Mutation Testing
The AAFP recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2). (2005)
(Grade: D recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm
(Grade: D recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm