Primary care physicians play a pivotal role in encouraging patients to get regular breast cancer screenings. Having specific screening knowledge helps PCPs navigate patient confusion about screening guidelines. Watch this short video on the three components of breast cancer screening—brought to you by Andrea Porpiglia, MD, MSc, FACS, Assistant Professor, Department of Surgical Oncology at Fox Chase.
Three Components of Breast Cancer Screening
Breast Awareness
Each patient must know her breasts and be aware of what changes are normal for her.
Clinical Breast Exam (CBE)
Asymptomatic women between 25-39 years old with no risk factors should undergo a CBE every 1-3 years.
Women over age 40, women with increased risk factors for breast cancer, women with a history of breast cancer and/or who are symptomatic should undergo more frequent CBE.
Breast Imaging
Women who are at average risk should get an annual digital screening mammographystarting at age 40.
Women who are at increased risk should get an annual breast MRI in addition to annual mammograms.
Fox Chase offers a Risk Assessment Program for individuals and families at risk for cancer and those with cancer, including breast, ovarian, gastrointestinal, endocrine, kidney, diffuse gastric, uterine and skin cancers. Our team of physicians, nurses and genetic counselors provides clinical and genetic evaluation and testing, screening and cancer risk-reduction services. To learn more, visit FoxChase.org/rap 877-627-9684 .
Hi, my name is Andrea paraphernalia and I'm an assistant professor of surgical oncology at Fox Chase Cancer Center. Today, I'm gonna be talking about breast cancer screening for primary care providers. The reason it's so important is that the average lifetime risk of a woman to develop breast cancer is one in eight. And of those 85% of breast cancers or current women who have no family history and therefore it's very important for women to undergo screening mammography. Breast cancer is the most commonly diagnosed cancer among american women. An off note in 2021 is the most common cancer globally, representing 12% of all new cancers worldwide. Now there's three components of breast cancer screening. The first is breast awareness and that's really for the patient. The second is clinical encounters which include clinical breast exam and breast cancer risk assessment. And last is breast imaging. So your clinical encounter should really include for asymptomatic women between the ages of 25-39 years With no risk factors. They should go undergo clinical breast exams every 1-3 years. Women over the age of 40. Women with increased risk factors for breast cancer. If you have a history of breast cancer and or symptomatic should undergo more frequent clinical breast exams included in this clinical encounter should be risk reduction counseling and that includes diet and exercise. You should decrease alcohol consumption and also avoid using hormonal replacement therapies. So who is considered to be at increased risk for breast cancer firstly. Women with a prior history of breast cancer. Women who are over the age of 35 years with a five year risk of invasive breast cancer more than 1.7% based on the gail model. Women who have a lifetime risk more than 20% based on their history of lobular carcinoma in side too atypical ductal hyperplasia, an atypical lobular hyperplasia. Women who have a lifetime risk more than 20% defined by other models, such as the tire acoustic model, that is mostly dependent on family history. Women between the ages of 10 and 30 years with prior thoracic radiation And one with a strong family history suggestive or have a known genetic predisposition. So what are some pros and cons of starting mammograms at the age of 40. This is a big debate in the literature. The American cancer society recommends starting at the age of 50. However, many other institutions recommend starting at age of 40. So some cons about starting earlier. One is the concern for false positive results. Many women do not consider a false positive that harm. So you undergo the biopsy, you have a benign result, they're related And less than 1% of screen women per year will be recommended for biopsy that is proven to be benign. So therefore it's a small percentage of patients. The other concern is over diagnosis. There are current studies that note over diagnosis. Women between 40 and 49 is 0.3-1%, which is very low. Now, some pros for starting at the age of 41. You have early detection of breast cancer. That decreases mortality. It leads a less aggressive treatment for these women and it increases their treatment options. It identifies women with high risk lesions and therefore you can screen them more carefully. And then lastly there's randomized controlled trials case controlled observational studies and computer modeling studies demonstrating the benefit of reduction in breast cancer related mortality with demographics screening. And that's why the n. c. c. n. and other organizations are recommending starting at the age of 40. So then the question becomes do you do it every year or every other year? And when do you stop screening? So the cancer intervention and surveillance smiling network found that the benefit of screening women between the ages of 40 and 49 with annual mammography saves 30% more lives and 34% more life years than bi annual mammography. And then when should you stop and really you should consider stopping annual mammography when patients have severe conditions limiting life expectancy and no intervention will be recommended based on the screening findings and therefore it doesn't matter what age you are. If the women if you're not going to act upon those results then you should not get the mammogram. Now it gets a little bit more complicated when you're talking about women who have increased risk of breast cancer and therefore really should be referred to a breast specialist and or genetic counselor discuss this further. However, we do recommend increasing their screening with annual breast mris in addition to the annual mammograms. And then you also consider mammograms with tomoe synthesis In the clinical counter should really be every six or 12 months. Thank you for your time today.
