By vgreene, 9 September, 2015 If hx breast CA for invasive cancer physical exam 1 4x per yr x5y then annually 10 for DCIS physical exam q6 12mo x5y then annually NCCN10 ASCO9 recommends physical exam q3 6mo for first 3y then q6 12mo for yrs 4 and 5 then annually
By vgreene, 9 September, 2015 Screen mod increased risk1 2 pts w mammography tomosynthesis guidance varies discuss benefits3 harms 4 Adjunctive MRI guidance varies
By vgreene, 9 September, 2015 If dense breasts (BI-RADS C/D): insufficient evidence on alt/supplemental approaches in pts w/o other risk factors (ACOG,14 ACS8); NCCN15 recommends counseling re: risk/benefits of supplemental screening. Massachusetts approach:16 Consider adjunct MRI/US,
By vgreene, 9 September, 2015 If 5-yr Gail Model risk ≥1.7% (pts ≥35 yo): annual mammogram, once identified as increased risk; consider tomosynthesis and risk reduction strategies (NCCN12)
By vgreene, 9 September, 2015 For LCIS: consider MRI on case-by-case, factoring age, FHx, bx features, breast density, pt preference (ACS13)
By vgreene, 9 September, 2015 If lifetime breast CA risk 15%-20% (per tool based mainly on FHx): ACR recommends annual mammography (or tomosynthesis);5 adjunctive MRI (w/ and w/o contrast) is considered usually appropriate7
By vgreene, 9 September, 2015 Insufficient evidence regarding adjunctive MRI for breast CA/DCIS/LCIS/ADH/ALH pts (ACS3,13)
By vgreene, 9 September, 2015 If LCIS/ALH/ADH: annual mammogram (ACR,5 NCCN,6 ACOG11); ACR5 rates tomosynthesis equivalent w/ mammography; NCCN12 specifies not starting mammography