Breast Cancer

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Breast Cancer, Mammography, Before age 50

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(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm(www.uspreventiveservicestaskforce.org)

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(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm(www.uspreventiveservicestaskforce.org)

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(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm(www.uspreventiveservicestaskforce.org)

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(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm(www.uspreventiveservicestaskforce.org)

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(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm(www.uspreventiveservicestaskforce.org)

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(www.uspreventiveservicestaskforce.org)
Clinical Considerations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm(www.uspreventiveservicestaskforce.org)

Breast Cancer, Prevention Medication

The AAFP recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications such as tamoxifen or raloxifene. (2013)

(Grade: B recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespre.htm#drec)(www.uspreventiveservicestaskforce.org)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm#clinical)(www.uspreventiveservicestaskforce.org)

Breast Cancer, Prevention Medication

The AAFP recommends against the routine use of medications, such as tamoxifen or raloxifene, for risk reduction of primary breast cancer in women who are not at increased risk for breast cancer. (2013)

(Grade: D recommendation)
(Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/gradespre.htm#drec(www.uspreventiveservicestaskforce.org)
(Clinical Considerations: http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm#clinical(www.uspreventiveservicestaskforce.org)

Breast Cancer/BRCA Mutation Testing

The AAFP recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with one of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing. (2013)

(Grade: B recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#brec(www.uspreventiveservicestaskforce.org)
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrs.htm#consider(www.uspreventiveservicestaskforce.org)

Breast Cancer/BRCA Mutation Testing

The AAFP recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes. (2013)

(Grade: D recommendation)
Grade Definition: http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm#brec(www.uspreventiveservicestaskforce.org)
Clinical Consideration: http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrs.htm#consider(www.uspreventiveservicestaskforce.org)

(www.uspreventiveservicestaskforce.org)