Breast Cancer Assessment

Suggested Guidelines for Asymptomatic Patients

If you are treating an asymptomatic patient, follow these three steps and consult the topics below.

1. Update the patient’s personal and family history for cancers (especially breast and ovarian).
2. Review the criteria for recommending genetic testing (for patients without a known genetic predisposition to breast cancer) and advise patients accordingly.
3. Assess the patient’s risk status, including increased risk for patients:
   1. with a known genetic predisposition to breast cancer,
   2. who underwent therapeutic radiation before age 30,
   3. with a history of atypical hyperplasia, or
   4. with reproductive risk factors.

Family History

• Note the relationship (i.e., parent, sibling, aunt, uncle) and the age at onset for each relative
• First degree relative = parent, sibling, child
• Second degree relative = other blood relatives excluding great-grandparents and cousins

Clinical Breast Exams

• The efficacy of clinical breast exams (CBEs) has not been evaluated independent of mammography. Clinicians might, however, consider a periodic CBE as an opportunity to engage their patients in discussion about overall breast evaluation. For patients at elevated risk, annual CBEs should be considered as part of the comprehensive assessment.

Mammograms

• Screening recommendations for patients at usual risk vary among experts. The CRICO Breast Care Management Algorithm recommendations are based on the 2016 United States Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network recommendations.
• The decision to start regular, biennial screening mammography before age 50 should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. (USPSTF)

Risk Prediction Models

• For women ≥ age 35, prediction models establish their 5- or 10-year risk. Commonly used tools include:
  
  • The Gail Model, which calculates actuarial estimates of future breast cancer risk based on race, age, reproductive risk factors, maternal family history, and previous biopsy status. The Gail Model calculates the risk of developing cancer over the next five years. Note that the Gail Model may underestimate the risk for patients with a strong family history of breast or ovarian cancer. [bcrisktool.cancer.gov]
  • The Breast Cancer Surveillance Consortium Risk Calculator calculates 5- and 10-year breast cancer risk estimates based on age, race/ethnicity, family history, history of a breast biopsy, and breast density. [tools.bcsc-scc.org]
• For patients with a significant family history of breast cancer, consider models such as Claus or Tyler-Cusick, or a referral for genetic testing.

See Also:

• Breast Cancer Screening
• CRICO Breast Care Management Algorithm Test