Nadra Moulayes DOSovereign Medical Group

St. Joseph’s Regional Medical CenterDepartment of Surgery

Division of Breast Surgery

The most common cancer among women in the United States.

Second leading cause of cancer-related death in women.

2014: more than 230,000 women will be diagnosed with breast cancer; claiming ~ 40,000 lives.

Since 1990’s breast cancer mortality rates have been dropping (avg. 2-3% per year).

Breast Cancer 80% sporadic 15% hereditary 5% genetic mutation Life time risk ↑ with age:

30-40 1.5% 40-50 2.8% 50-60 3.4% 60-70 3.1 % Cumulative life-time risk for general population is

~11%.

Age Family History/gene mutation Clinical Factors

Proliferative disease with atypia Chest wall radiation at younger age Dense breast

Reproductive Factors Prolonged hormonal exposure

Obesity Tobacco Alcohol? Diet?

Risk Calculation model Gail Tyer Cusak Claus Myriad

<12% general population risk 12-20% intermediate risk ≥ 20% high risk

Age 40-49 Multiple studies have shown ~ 24% reduction

in mortality risk. USPSTF systemic review reported that

mammography reduces breast cancer mortality by 15% with over-diagnosis ~1-10%informed/shared decision.

ACOG, ACS and NCCN: annual screening.

Ages 50-69 Multiple randomized trials: breast cancer

mortality reduced up to 20%. USPSTF: biennial screening NCCN: annual screening

Ages 70 years and older USPSTF:

insufficient evidence of benefits. Biennial screening until age of 74. 75 years or older patient’s based.

Decision for screening is patient/practitioner based.

Literature: As high 37% of all cancers in women with

dense breasts were detected only with breast ultrasound.

Supplemental US detected additional 4.2 cancers per 1000 women.

Now indicated for women with dense breast on mammography.

Breast Self-Examination (BSE): USPSTF: recommend against BSE ACS, NCCN & ACOG: encourage BSE

Clinical Breast Examination (CBE): USPSTF: insufficient evidence for benefits in

women 40 years of age & older. NCCN: continues to recommend.

In average risk patients: high false-positive rate & over-diagnosis. Benefits vs harms not determined not

recommended for screening. ACS & NCCN: annual MRI in addition to

mammogram for high risk patients: self/1st degree relative with known gene mutations. Patient with hx. of chest wall radiation between 10-

30 years of age. Insufficient evidence: LCIS, ADH, dense

breasts, personal hx. Of BC, or lifetime risk <20%.

National Cancer Comprehensive Network Guidelines. Available @ www.nccn.org/professionals/physician_gls/f_guidelines.asp

U.S Preventive Service Task Force Recommendations. Available @ www.uspreventiveservicetaskforce.org

Nemec et al. How should we screen for breast cancer? Mammography, ultrasonography, MRI. Cleve Clin J Med 2007;74:897-904

Kolv et al. Comparison of the performance of screening, physical exam and breast ultrasound and evaluation of factors that influence them: an analysis of 27,825 patients evaluation. Radiology 2002;225 (1)165-75