Breast cancer screening resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2], Rim Halaby, M.D. [3]

Overview

Breast cancer screening is an attempt to find unsuspected cancers. The most common screening methods include: self and clinical breast exams, x-ray mammography, breast magnetic resonance imaging (MRI), ultrasound, and genetic testing.

BRCA Testing

Approach to Genetic Testing

Assess women with: ❑ No previous diagnosis with BRCA related cancer, and ❑ Absence of signs and symptoms of any BRCA related cancer
Risk assessment: is ANY of the following history factors present? ❑ Family members with breast, ovarian, tubal or peritoneal cancer ❑ Breast cancer diagnosis before age of 50 years ❑ History of bilateral breast cancer ❑ Presence of both breast and ovarian cancer ❑ Breast cancer in one or more male family members ❑ Multiple breast cancer cases in the family ❑ One or more family members with two primary types of BRCA related cancers ❑ Ashkenazi Jewish ethnicity
Yes?
Screening with ANY of the following: ❑ Ontario Family History Assessment Tool ❑ Manchester Scoring System ❑ Referral Screening Tool ❑ Pedigree Assessment Tool ❑ FHS-7
High risk of potentially harmful BRCA mutation based on screening?
Genetic counseling ❑ Risk assessment for presence of potential BRCA mutation ❑ Educating patients about the possible genetic testing results ❑ Risk assessment of family members to identify suitable candidates for genetic testing ❑ Discussion about risk reducing interventions ❑ Post-test counseling
BRCA mutation genetic testing

Algorithm based on the 2013 US Preventive Services Task Force recommendation statement.