Breast Cancer

Work on the CRICO/RMF Breast Care Management Algorithm began in the early 1990s, when CRICO-insured primary care providers expressed concern over the frequency of malpractice claims alleging a failure to diagnose breast cancer. The first iteration was published in 1995, has since undergone four revisions, culminating in the most recent (2009) edition. CRICO/RMF is most grateful for the contributions the expert oncologists, breast surgeons, radiologists, obstetrician/gynecologists, and primary care physicians who have served on the Breast Care Task Force or as peer reviewers.

For questions about the CRICO/RMF Breast Care Management Algorithm, contact CRICO/RMF Director of Loss Prevention/Patient Safety, Ann Louise Puopolo.

Changes to CRICO/RMF Breast Care Management Algorithm (November 2009)

In the process of publishing the most recent (2009) version of the CRICO/RMF Breast Care Management Algorithm, the following changes or enhancements were made:

Additions

  • Risk Management for Breast Care section
    Tips on risk factor assessment and for managing test results, referrals, and patients with a self-detected mass.
  • CRICO Malpractice Claims Data from 2004-2008
    Prevalence of breast cancer cases, most frequently named physician specialties, where in the process of care systems breakdowns occur.
  • Important Physician-patient Discussion Points Related to Breast Patient Safety
    Guidance for primary care providers on aligning expectations related to issues or complaints that, if mismanaged, can put patients at risk and unnecessarily expose providers to allegations of malpractice.

Revisions

  • Updated and streamlined the Risk Assessment section. Provides primary care givers with a simpler, more logical process for stratifying a patient's risk for breast cancer and the associated recommendations for screening.
  • Adopted the NCCN guideline recommending annual screening mammogram beginning at age 40. Previous recommendation was "at least biennially" for women age 40-49.
  • Broaden recommendations for the use of MRI (in addition to mammography) for patients at higher risk of breast cancer.
  • Strengthened the recommendations regarding communication of biopsy results between radiologists and PCPs.
  • Clarified the need for primary care providers to follow to a mutually satisfactory conclusion a patient's self-detected breast lump that the caregiver cannot confirm by exam.

FAQs

Cases

Effective Practices

Screening for Breast Cancer

CRICO/RMF Breast Care Management Algorithm Task Force

Robyn Birdwell, MD
Section Head of Breast Imaging
Brigham and Women's Hospital

Judy E. Garber, MD, MPH
Director, Cancer Risk and Prevention,
Department of Adult Oncology
Dana Farber Cancer Institute

Gila Kriegel, MD
Assistant Professor in Medicine
Beth Israel Deaconess Medical Center

Michelle Specht, MD
Assistant Professor in Surgery
Massachusetts General Hospital

Susan Troyan, MD, FACS
Surgical Director, Breast Care Center
Beth Israel Deaconess Medical Center