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Breast cancer is a leading cause of cancer mortality among women in the United States. Screening has been shown to increase early detection rates and decrease mortality rates. Evidence-based guidelines have been updated as knowledge has advanced. Screening recommendations from various organizations vary significantly. These variations—from screening modality, age to initiate and discontinue screening, and screening intervals—have led to confusion among patients and clinicians alike. Clinicians should be aware of the current screening recommendations so they can address questions patients may have about recommendation differences and to optimize early detection. Management of breast cancer is highly individualized and dependent on the subtype of cancer, the stage at diagnosis, patient preferences, and physician recommendations. Management may involve surgery, chemotherapy, radiation, and/or hormone therapy. Family physicians can help facilitate patient care throughout the screening, diagnosis, and treatment processes. Multiple factors contribute to disparities in breast cancer screening, management, and outcomes. Clinician knowledge of these factors can help reduce disparities in care and patient outcomes.

Case 3. Monica is a 42-year-old Black woman, who comes to your office for a well woman examination. She has never had a mammogram and wants to discuss breast cancer screening. You review her history. Menarche was at age 13 years. Other than intermittent oral contraceptive pill use in her 20s, she reports no use of hormonal drugs. She has three children (gravida 3, para 3). Her first pregnancy occurred when she was age 26 years, and she breastfed each of her children for 3 to 6 months. The medical history is significant only for obesity. Monica reports no tobacco or drug use and only occasional alcohol consumption. She reports no family history of breast cancer.

Breast cancer is the most common form of malignancy and the second leading cause of cancer mortality in women.82 A woman living in the United States has a 13% lifetime likelihood of being diagnosed with breast cancer.83 However, the risk rate in any specific age range is estimated to be significantly lower (2.4% 10-year risk for women at age 50 years; 3.5% at age 60 years; 4.1% at age 70 years). Approximately 3% of women diagnosed with cancer will die of breast cancer.

Risk Factors

After female sex, the greatest risk factor for breast cancer is increasing age. Additional risk factors include personal history of breast, ovarian, or endometrial cancer; genetic mutations; first term pregnancy after age 30 years; history of high-dose chest radiation; no full-term pregnancies; never breastfeeding; menarche at younger than 11 years; menopause at 55 years or older; and family history.83

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