Breast Cancer Pathway Map - cancercareontario.ca · DISCLAIMER: This pathway is a resource that provides an overview of the presentation and clinical work-up of a cancer diagnosis

DISCLAIMER: This pathway is a resource that provides an overview of the presentation and clinical work-up of a cancer diagnosis that an individual in the Ontario cancer system may receive. The pathway is intended to be used for informational purposes only. The pathway is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. Further, all pathways are subject to clinical judgment and actual practice patterns may not follow the proposed steps set out in the pathway. In the situation where the reader is not a healthcare provider, the reader should always consult a healthcare provider if he/she has any questions regarding the information set out in the pathway. The information in the pathway does not create a physician-patient relationship between Cancer Care Ontario (CCO) and the reader. While care has been taken in the preparation of the information contained in the pathway, such information is provided on an as-is basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the informations quality, accuracy, currency, completeness, or reliability. CCO and the pathways content providers (including the physicians who contributed to the information in the pathway) shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the pathway or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the pathway does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such persons use of the information in the pathway. This pathway may not reflect all the available scientific research and is not intended as an exhaustive resource. CCO and its content providers assume no responsibility for omissions or incomplete information in this pathway. It is possible that other relevant scientific findings may have been reported since completion of this pathway. This pathway may be superseded by an updated pathway on the same topic.

Cancer Care Ontario

Breast Cancer Pathway Map

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Follow-UpTreatmentDiagnosisScreeningPrevention

Risk Assessment & Prevention

Guidance

(Page 2)

Screening Risk Assessment

(Page 3)

Average Risk Screening

(Page 4)

High Risk Screening

(Page 5)

Assessment of Symptomatic

Individuals

(Page 6-7)

Diagnostic Procedures

(Page 8-9)

Ductal Carcinoma In Situ

(Page 10-11))

Invasive Breast Cancer

(Page 12-17)

Distant Metastases

(Page 18)

Local and/or Regional

Recurrence

(Page 19-20)

Survivorship

(Page 21-22)

End of Life Care

(Page 23)

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Risk Assessment & Prevention Guidance Risk Assessment & Prevention Guidance Risk Assessment & Prevention Guidance Risk Assessment & Prevention Guidance Risk Assessment & Prevention Guidance Risk Assessment & Prevention Guidance Risk Assessment & Prevention Guidance


DECISION POINT

Discuss appropr iatebreast screening andOBSP average r iskeligibility

MULTIPLE/UNSPECIFIEDSPECIALTY DEC-22

CHARACTERISTIC A

Connected to Screening | INT-124

Eligible

CHARACTERISTIC B

Not eligibleFOLLOW-UP

Follow-up managedby Pr imary CareProvider

PRIMARY CARE FOL-3

DECISION POINT

Discuss appropr iatebreast screening andreassess High RiskOBSP eligibility


CHARACTERISTIC A

Connected to Screening | DEC-18

Eligible

CHARACTERISTIC B

Not eligible (i.e. age, bilateralmastectomy)

INTERVENTION

ChemopreventionConsidered if age 35 years;assessment forappropriateness using Gail riskscore or other risk assessmentmodel

MULTIPLE/UNSPECIFIEDSPECIALTY INT-109

Resources / Tools

U.S. Preventive Services TaskForce (USPSTF)recommendation on the use ofmedications for breast cancerrisk reduction.

INTERVENTION

Assessment of breastcancer r isk by familyphysician or otherhealthcare provider,or tool (i.e. My CancerIQ)Lifetime risk of breast cancershould be based on familyhistory and must be assessedusing IBIS or BOADICEAlifetime risk assessment tools.IBIS 10 year and BOADICEA 5year risk assessment tools


Resources / Tools

My Cancer IQ

IBIS risk assessment

BOADICEA risk assessment

Hide

INTERVENTION

Refer to GeneticsProgram for formalassessment ofhereditary breastcancer r isk andgenetic test wheneligible

GENETICS INT-111

CONSULTATION

Refer ral toappropr iateHealthcare ProviderI.e. medical oncologist,surgeon, gynecologist,primary care provider

MULTIPLE/UNSPECIFIEDSPECIALTY CON-44

CHARACTERISTIC

From High Risk OBSPScreening Program

MULTIPLE/UNSPECIFIEDSPECIALTY CHA-12

CONSULTATION



DECISION POINT

Assessment outcome


CHARACTERISTIC A


Potentially eligible for HighRisk OBSP program

Refer for assessment via OBSPRequisition for High Risk Screening

CHARACTERISTIC B

Eligible for geneticassessment but not eligiblethrough High Risk OBSPprogram (e.g. strong familyhistory & 18 to 29 years ofage)

CHARACTERISTIC C

Average lifetime risk of breastcancer

Lifetime risk of breast cancershould be based on family historyand must have been assessedusing IBIS or BOADICEA lifetime

CHARACTERISTIC D

Increased risk of breast cancerfor non-genetic reasons (i.e.high risk lifestyle, alcohol,smoking, obesity, age)

Resources / Tools

OBSP Requisition for High RiskScreening

Show all

DECISION POINT

Results of geneticassessment(s)


CHARACTERISTIC A

Carrier of pathogenic variant inBRCA 1/2

CHARACTERISTIC B

25% lifetime risk of breastcancer or carrier of pathogenicvariant in other penetrantgenes (e.g. TP53, CDH1,PTEN, STK11, CHEK2,


CHARACTERISTIC C

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Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment

Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment Screening Risk Assessment

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INTERVENTION

Formal assessment ofher editary br eastcancer risk

GENETICS INT-117

Resour ces / Tools

OBSP Breast Cancer GeneticAssessment and/or T est Results

DECISION POINT

Genetic TestingEligibility


CHARACTERISTIC A

Eligible

CHARACTERISTIC B

Not eligible or patient declinestesting

CONSULTATION

Referral to OBSP forbr east cancer geneticassessment todetermine eligibilityfor High Risk OBSPNurse practitioners can assesspatient risk and complete theOBSP requisition for high risk

GENETICS CON-47

Resour ces / Tools


INTERVENTION

Patient declinesgenetic r eferral


DECISION POINT

Clinical pr esentation


CHARACTERISTIC A

Asymptomatic

CHARACTERISTIC B

Connected to Diagnosis | CHA-14

Symptomatic or a finding onclinical exam

CONSULTATION

Visit to Healthcar ePr oviderAverage Risk patients do notrequire a physician referral forthe OBSP


CONSULTATION

Patient self-r efers toOBSP


Resour ces / Tools

OBSP Screening Locations

DECISION POINT

Eligibility and riskassessment todetermineappr opriate scr eeninge.g. family and clinicalhistoryNurse practitioners can assesspatient risk and complete the


CHARACTERISTIC A


Average Risk

Women are considered eligible foraverage risk screening if they areasymptomatic and meet all of thefollowing:1) Are 50-74 years ofage*;2) Have no personal historyof breast cancer;3) Have not had ascreening mammogram within last11 months;4) No current breastimplants

*Women over age 74 canbe screened with the OBSP;however, they are encouraged to

CHARACTERISTIC B

Possible High Risk (Geneticassessment required todetermine High Risk OBSPeligibility)

Women may be eligible for highrisk screening if they areasymptomatic, are 30-69 years of

CHARACTERISTIC C

Known High Risk (Eligible fordirect entry into High RiskOBSP)

Women may be eligible for highrisk screening if they areasymptomatic, are 30-69 years of

CHARACTERISTIC D

Not eligble for OBSP (e.g. 74 years of age)*

*Women over age 74 can bescreened with the OBSP; however,they are encourage to make a

Resour ces / Tools

CCO Cancer Screening forBreast Cancer


Hide

INTERVENTION

Health car e pr oviderdiscusses riskappr opriate scr eeningand discusses healthbehaviourinterventions toreduce br east cancerrisk as appr opriate(e.g. exercise, nutrition)

There is insufficient evidenceto recommend appropriatescreening guidelines for somerisk categories (e.g. a 40 yearold woman at increased butnot high risk). Risk appropriatescreening in these cases is apersonalized decision madebetween the woman and herhealthcare provider.

PRIMARY CARE INT-119

Guidelines

EBS #23-1 - Healthy Eating,Physical Activity , and HealthyWeights Guideline for PublicHealth in Ontario

DECISION POINT

Reevaluate patientrisk


CHARACTERISTIC A


Connected to Prevention | CHA-12

25% lifetime risk of breastcancer


CHARACTERISTIC B

< 25% lifetime risk of breastcancer


Resour ces / Tools



Hide

INTERVENTION

Genetic Test

GENETICS INT-120

Resour ces / Tools

OBSP Breast Cancer GeneticAssessment and/or T est Results

DECISION POINT

Results


CHARACTERISTIC A



Carrier of pathogenic variant inBRCA 1/2 or carrier of otherhigh penetrant gene (e.g.TP53, CDH1, PTEN, STK11)

CHARACTERISTIC B

True negative result for knownhereditary gene mutation infamily

CHARACTERISTIC C

No deleterious mutationidentified or variant ofundetermined significance

INTERVENTION

Health car e pr oviderdiscusses riskappr opriate scr eeningand discusses healthbehaviourinterventions toreduce br east cancerrisk as appr opriate(e.g. exercise, nutrition)

There is insufficient evidenceto recommend appropriate


Guidelines

EBS #23-1 - Healthy Eating,Physical Activity , and HealthyWeights Guideline for PublicHealth in Ontario

INTERVENTION

Discuss scr eeningoptions withhealthcar e pr oviderwith r egards to thebenefits andlimitations ofscreening


INTERVENTION

Return to riskappr opriate scr eening


CONSULTATION

Referral to High RiskOBSPNurse practitioners can assesspatient risk and complete theOBSP requisition for high risk



Resour ces / Tools


Decision Point

Click to select between thefollowing options.

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Average Risk Screening Average Risk Screening Average Risk Screening Average Risk Screening Average Risk Screening Average Risk Screening Average Risk Screening Average Risk Screening Average Risk Screening

INTERVENTION

ScreeningmammogramEvery two years or annuallyas required for women ages50-74As outlined within the OBSP,annual mammograms may be

RADIOLOGY INT-124

Resour ces / Tools

CCO Cancer ScreeningRecommendations

DECISION POINT

Results The management following theBI-RADS assessmentcategories are based on therecommendations from theAmerican College ofRadiology.


CHARACTERISTIC A

Normal (e.g. BI-RADS 1 or 2)

CHARACTERISTIC B

Abnormal (e.g. BI-RADS 0)

Resour ces / Tools

ACR BI-RADS Atlas

DECISION POINT

Results


CHARACTERISTIC A

Benign diagnostic assessment(e.g. normal tissue, simplecyst, minimally complicatedcyst)

CHARACTERISTIC B

Probably benign diagnosticassessment (e.g. BI-RADS 3)

The management following theBI-RADS assessment categoriesare based on the recommendations

CHARACTERISTIC C

Connected to Diagnosis | DEC-39

Abnormal diagnosticassessment

Resour ces / Tools

ACR BI-RADS Atlas

DECISION POINT

Results


CHARACTERISTIC A

Normal assessment

Continuewith screening or diagnosticimaging follow-up

CHARACTERISTIC B


Abnormal assessment

INTERVENTION

Short-term imagingfollow-upRepeat imaging within 6months based on radiologist'srecommendations.

RADIOLOGY INT-125

FOLLOW-UP

Continue scr eening

MULTIPLE/UNSPECIFIEDSPECIALTY FOL-5

INTERVENTION

Diagnostic Assessment

INTERVENTION

DiagnosticMammogram

AND/OR

Ultrasound

RADIOLOGY INT-126

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Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals

Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals Assessment of Symptomatic Individuals

CHARACTERISTIC

Patient pr esents withone or mor esymptoms of br eastcancer , such as:-Palpable mass-Concerningnipple discharge-New nippleretraction-Skin changes of thenipple or breast-Asymmetricthickening/nodularity


DECISION POINT

Patient's Age


CHARACTERISTIC A

40 years of age

INTERVENTION

Clinical r eassessmentof symptoms


INTERVENTION

Healthcar e pr oviderdiscusses riskappr opriate scr eeningThere is insufficient evidenceto recommend appropriatescreening guidelines for somerisk categories (e.g. a 40 yearold woman at increased butnot high risk). Risk appropriatescreening in these cases is apersonalized decision madebetween the woman and herhealthcare provider.



INTERVENTION

Ultrasound

RADIOLOGY INT-129

DECISION POINT

Imaging Results


CHARACTERISTIC A

Normal

CHARACTERISTIC B

Probably benign (BI-RADS 3)

The management following theBI-RADS assessment categoriesare based on the recommendationsfrom the American College ofRadiology.

CHARACTERISTIC C


Suspicious

Resour ces / Tools

ACR BI-RADS Atlas

DECISION POINT

Results


CHARACTERISTIC A

Persistent suspicious findings

CHARACTERISTIC B

Normal assessment

DECISION POINT

Results


CHARACTERISTIC A

Normal assessment

CHARACTERISTIC B

Suspicious

FOLLOW-UP

INTERVENTION


RADIOLOGY INT-130

INTERVENTION

Clinical r eassessmentof symptoms

PRIMARY CARE INT-131INTERVENTION

INTERVENTION

Ultrasound

RADIOLOGY INT-132

INTERVENTION

Mammogram

RADIOLOGY INT-133

INTERVENTION

GalactographyIn appropriate clinical contexts

RADIOLOGY INT-134

INTERVENTION

INTERVENTION

Ultrasound

RADIOLOGY INT-135

INTERVENTION

Mammogram

RADIOLOGY INT-136

INTERVENTION

GalactographyIn appropriate clinical contexts

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Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures Diagnostic Procedures

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FOLLOW-UP

Consider short-termimaging follow-up orreturn torisk-appr opriatescreening


INTERVENTION

Second cor e needlebiopsy or vacuumbiopsyIf discordant upon secondbiopsy, refer to surgeon.

RADIOLOGY INT-138

CONSULTATION

Referral to Surgeon

SURGICAL ONCOLOGY CON-51

DECISION POINT

Results


CHARACTERISTIC A

Benign

CHARACTERISTIC B

High risk/concerning benignlesions

e.g. Atypical ductal hyperplasia,radial scars, papilloma

CHARACTERISTIC C

Cancer

CHARACTERISTIC D

Insufficient tissue sampling

CONSULTATION

Referral to Surgeon


INTERVENTION

Biopsy

SURGICAL ONCOLOGY INT-139

DECISION POINT

Finding(s)


CHARACTERISTIC A

Suspicious mass onultrasound, complex cyst,intraductal nodule, concerningcalcifications, suspiciousmammographic finding

An excisional biopsy may beconsidered for presumed isolatedpapillary lesions in the appropriateclinical context

CHARACTERISTIC B

Axillary lymph nodes:indeterminate or concerning

CHARACTERISTIC C

MRI suspicious lesion

Only for high risk patients

INTERVENTION

Cor e biopsyVacuum assisted with clipplacement

RADIOLOGY INT-140

CONSULTATION

Referral to Surgeon


INTERVENTION

Fine needle aspiration

OR

Cor e Biopsy

RADIOLOGY INT-141

DECISION POINT

Concordance withpathology , imagingand clinicalexamination


CHARACTERISTIC A

Concordant

CHARACTERISTIC B

Discordant

INTERVENTION

PathologyE.g. ER, PgR, HER2Biomarkers should beperformed on core biopsiesshowing invasive cancer.

PATHOLOGY INT-142

Resour ces / Tools

Summary Statement: 2013ASCO/CAP HER2 Guidelines:Building a Consensus forOntario

Breast T issue Pathway Map

Hide

INTERVENTION

Cor e biopsy

RADIOLOGY INT-143

DECISION POINT

Type of cancer


CHARACTERISTIC A

Connected to Treatment | CON-57


CHARACTERISTIC B



INTERVENTION

Healthcar e pr oviderdiscusses riskappr opriate scr eeningor short term imagingfollow-upThere is insufficient evidenceto recommend appropriatescreening guidelines for somerisk categories (e.g. a 40 yearold woman at increased butnot high risk). Risk appropriatescreening in these cases is apersonalized decision madebetween the woman and herhealthcare provider.



DECISION POINT

Type of cancer


CHARACTERISTIC A



CHARACTERISTIC B


CONSULTATION

Referral to Surgeon


INTERVENTION

Second cor e biopsy

RADIOLOGY INT-145

INTERVENTION

Biomarker TestingE.g. ER, PgR, HER2If not already initiated


PATHOLOGY INT-146

Resour ces / Tools

Summary Statement: 2013ASCO/CAP HER2 Guidelines:Building a Consensus forOntario


Hide

DECISION POINT

Results


CHARACTERISTIC A

Benign

CHARACTERISTIC B


Confirmed high risk benign

CHARACTERISTIC C

Cancer

DECISION POINT

Decision r egardingfurther diagnostictest(s) needed


CHARACTERISTIC A

Excisional biopsy or short-termimaging

CHARACTERISTIC B


Risk appropriate screening

INTERVENTION

PathologyBiomarkers should beperformed on core biopsiesshowing invasive cancer.

PATHOLOGY INT-147

Resour ces / Tools


INTERVENTION

Choose one of the following:

INTERVENTION

Excisional biopsy


FOLLOW-UP



Decision Point

Click to select between thefollowing options.

Ductal Car cinoma InSitu

Invasive Br eastCancer

Distant Metastases

Local and/orRegional Recurr ence

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

Invasive Breast C

ancerInvasive B

reast Cancer

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Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer

Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer Invasive Breast Cancer

Jump

Jump

Jump

DATA 4INTERVENTION

Breast conservingsurgery and axillarylymph node dissection Consultation with plasticsurgeon may be appropriate insome cases


Guidelines

EBS #1-1 - SurgicalManagement of Early-StageInvasive Breast Cancer

EBS #17-5 - Sentinel L ymphNode Biopsy in Early-StageBreast Cancer

Hide

CONSULTATION

Radiation Oncologist

RADIATION ONCOLOGY CON-6

INTERVENTION

Pathology If no cancer in surgicalspecimen (e.g. very smalltumours,

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

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Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

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DECISION POINT



CHARACTERISTIC A


Eligible

CHARACTERISTIC B



PRIMARY CARE FOL-3

DECISION POINT



CHARACTERISTIC A


Eligible

CHARACTERISTIC B


INTERVENTION



Resources / Tools


INTERVENTION



Resources / Tools

My Cancer IQ



Hide

INTERVENTION


GENETICS INT-111

CONSULTATION



CHARACTERISTIC



CONSULTATION



DECISION POINT

Assessment outcome


CHARACTERISTIC A




CHARACTERISTIC B


CHARACTERISTIC C



CHARACTERISTIC D


Resources / Tools


Show all

DECISION POINT



CHARACTERISTIC A


CHARACTERISTIC B



CHARACTERISTIC C

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

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DECISION POINT

Discuss appr opriatebr east scr eening andOBSP average riskeligibility


CHARACTERISTIC A


Eligible

CHARACTERISTIC B


Follow-up managedby Primary Car ePr ovider

PRIMARY CARE FOL-3

DECISION POINT

Discuss appr opriatebr east scr eening andreassess High RiskOBSP eligibility


CHARACTERISTIC A


Eligible

CHARACTERISTIC B


INTERVENTION

Chemopr eventionConsidered if age 35 years;assessment forappropriateness using Gail riskscore or other risk assessmentmodel


Resources / Tools


INTERVENTION

Assessment of br eastcancer risk by familyphysician or otherhealthcar e pr ovider,or tool (i.e. My CancerIQ)Lifetime risk of breast cancershould be based on familyhistory and must be assessedusing IBIS or BOADICEAlifetime risk assessment tools.IBIS 10 year and BOADICEA 5year risk assessment tools


Resources / Tools

My Cancer IQ



Hide

INTERVENTION

Refer to GeneticsPr ogram for formalassessment ofher editary br eastcancer risk andgenetic test wheneligible

GENETICS INT-111

CONSULTATION

Referral toappr opriateHealthcar e Pr oviderI.e. medical oncologist,surgeon, gynecologist,primary care provider


CHARACTERISTIC

Fr om High Risk OBSPScreening Pr ogram


CONSULTATION

Referral toappr opriateHealthcar e Pr oviderI.e. medical oncologist,surgeon, gynecologist,primary care provider


DECISION POINT

Assessment outcome


CHARACTERISTIC A




CHARACTERISTIC B


CHARACTERISTIC C



CHARACTERISTIC D


Resources / Tools


Show all

DECISION POINT



CHARACTERISTIC A


CHARACTERISTIC B



CHARACTERISTIC C

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Prevention Guidance

Risk A

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Risk A

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DECISION POINT



CHARACTERISTIC A


Eligible

CHARACTERISTIC B



PRIMARY CARE FOL-3

DECISION POINT



CHARACTERISTIC A


Eligible

CHARACTERISTIC B


INTERVENTION



Resources / Tools


INTERVENTION



Resources / Tools

My Cancer IQ



Hide

INTERVENTION


GENETICS INT-111

CONSULTATION



CHARACTERISTIC



CONSULTATION



DECISION POINT

Assessment outcome


CHARACTERISTIC A




CHARACTERISTIC B


CHARACTERISTIC C



CHARACTERISTIC D


Resources / Tools


Show all

DECISION POINT



CHARACTERISTIC A


CHARACTERISTIC B



CHARACTERISTIC C

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

ssessment &

Prevention Guidance

Risk A

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Risk A

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Risk A

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Risk A

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Risk A

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DECISION POINT



CHARACTERISTIC A


Eligible

CHARACTERISTIC B



PRIMARY CARE FOL-3

DECISION POINT



CHARACTERISTIC A


Eligible

CHARACTERISTIC B


INTERVENTION



Resources / Tools


INTERVENTION



Resources / Tools

My Cancer IQ



Hide

INTERVENTION


GENETICS INT-111

CONSULTATION



CHARACTERISTIC



CONSULTATION



DECISION POINT

Assessment outcome


CHARACTERISTIC A




CHARACTERISTIC B


CHARACTERISTIC C



CHARACTERISTIC D


Resources / Tools


Show all

DECISION POINT


MULTIPLE/UNSPECIF

Documents

Breast Cancer Pathway Map - cancercareontario.ca · DISCLAIMER: This pathway is a resource that provides an overview of the presentation and clinical work-up of a cancer diagnosis