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Breast Care Screening Mammogram

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Breast Care Screening Mammogram

Related to: Clinical Guidelines, Primary Care, Other Specialties

Clinicians should use this decision support tree for follow up on a screening mammogram. This is not appropriate for women with breast complaints. The BIRADS number key follows this chart. Also refer to the recommendations for screening by age.

screeningmammo_flowchart


Screening by Age

Screening recommendations for patients at usual risk vary among experts.

The following recommendations are based on the 2013 NCCN Guidelines.

  • Women 40–69 years old should be screened annually.
  • Women more than 70 years old should be screened at least biennially, with consideration for overall quality of life.

Screening Technology

  • Overall, digital mammography is of equivalent sensitivity to film/screen
  • mammography.
  • Digital mammography has slightly better sensitivity than film/screen
  • mammography for women less than age 50, with dense breasts,
  • and/or pre-menopausal.
  • Data do not support the use of whole breast ultrasound or MRI as screening tools for women at usual risk with or without dense tissue or numerous calcifications.

American College of Radiology Breast Imaging Reporting and Data System (BIRADS)

0   Assessment is incomplete; additional imaging needed  
1     Negative  
2   Benign finding  
3   Probably benign finding—short interval follow-up suggested. Probable risk of breast cancer 2%.  
4   Suspicious abnormality—biopsy should be considered. Probable risk of breast cancer:
  a) low suspicion (<15%)
  b) intermediate suspicion (15–60%)
  c) high suspicion (60–95%)

 
5     Highly suspicious of malignancy—do biopsy. Probable risk of breast cancer is greater than 95%.  
6   Known biopsy-proven malignancy—appropriate action should be taken.  

   

Footnotes

a.      Patients should be informed about their options for image-guided core needle biopsy.
b.   Consider referral to surgeon for excision of mass >2cm.
c.   Ductal carcinoma in situ or invasive cancer.
d.   Lesions that may fit this category include LCIS, atypical lobular hyperplasia, atypical ductal hyperplasia, radial scar (benign sclerosing lesion), some papillary lesions, mucin-producing lesions, and potential phyllodes tumor.


March 3, 2014
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