Breast Cancer Screening (General Population)
We discussed the USPSTF recommendation of q1-2y mammogram (with or without CBE) and the ACOG, ACS, and ACR recommendations of annual screening mammograms (with CBC and SBE) starting at age 40 and older.
She chooses to follow the USPSTF recommendation of the q1-2y mammogram (with CBE).
Breast Cancer Prevention with Tamoxifen or Raloxifene in women at increased risk of breast cancer
Breast Cancer preventive medications (for women at increased risk for breast cancer)
The USPSTF recommends that clinicians engage in shared, informed decisionmaking with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene.
Tamoxifen 20 mg PO QD x5y OR
Raloxifene 60 mg PO QD
BRCA risk Assessment and Genetic Counseling
-The BRCA1 and BRCA2 genes are tumor suppressor genes. “Risks for breast, ovarian, and other types of BRCA-related cancer are greatly increased in patients who have inherited potentially harmful BRCA1 or BRCA2 mutations.”
-See USPSTF recommendation…
- Woman has a family member with a Breast TOP (Tubo-Ovarian and Peritoneal cancer) >
- PCP screens her using a recommended screening tool >
- PCP refers positive screens to genetic Counseling >
- BRCA testing after counseling, if indicated.
Family History Screening and Risk Assessment
Mutations in the BRCA genes cluster in families, exhibiting an autosomal dominant pattern of transmission in the maternal or paternal lineage.
“For women who have at least 1 family member with breast, ovarian, or other types of BRCA-related cancer, primary care providers may use 1 of several brief familial risk stratification tools to determine the need for in-depth genetic counseling. Although several risk tools are available, the tools evaluated by the USPSTF include the Ontario Family History Assessment Tool, Manchester Scoring System, Referral Screening Tool, Pedigree Assessment Tool, and FHS-7.” USPSTF
The Referral Screening Tool and FHS-7 are the simplest and quickest to administer. I prefer the FHS-7 tool.
“In general, these tools elicit information about factors that are associated with increased likelihood of BRCA mutations. Family history factors associated with increased likelihood of potentially harmful BRCA mutations include breast cancer diagnosis before age 50 years, bilateral breast cancer, presence of breast and ovarian cancer, presence of breast cancer in 1 or more male family members, multiple cases of breast cancer in the family, 1 or more family members with 2 primary types of BRCA-related cancer, and Ashkenazi Jewish ethnicity. The USPSTF recognizes that each risk assessment tool has limitations and found insufficient comparative evidence to recommend one tool over another. The USPSTF also found insufficient evidence to support a specific risk threshold for referral for testing.”USPSTF
Reference
https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/ [Last Updated, 10/2017]