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Breast Cancer Guidelines for Physicians

Screening:

  • Annual physical examination
  • Screening mammogram every two years between ages 40-50, annually thereafter. Stop
    screening if patient has less than 5-year life expectancy.
  • Limit use of hormone replacement therapy
  • Gail Model high risk category >1.7% at 5 years
  • Refer to oncologist for risk reduction

Assess:
Risk Factors - female gender; early menarche; late menopause; older age at first childbirth; prolonged hormone replacement therapy; prior chest irradiation; increasing age; benign proliferative breast disease; family history of pre-menopausal breast/ovarian cancer; BRCA 1/2 mutations.

Palpable Mass:
Diagnostic mammogram ASAP; ultrasound if recommended; referral to surgeon even if the ultrasound/mammogram is normal.

Lobular Carcinoma in situ (LCIS):

  • This is a risk factor for invasive cancer (21% at 15 years)
  • Physical examination every 6-12 months
  • Annual screening mammogram
  • Referral to oncologist for risk reduction
  • If on tamoxifen, with intact uterus, needs annual pelvic exam

Ductal Carcinoma in situ (DCIS):

  • Complete removal by surgery +/- radiation therapy
  • Annual screening mammogram
  • Annual physical examination
  • Referral to oncologist for risk reduction
  • If on tamoxifen, with intact uterus, needs annual pelvic exam

Invasive Breast Cancer (after definitive therapy):

  • Annual physical examination
  • Annual screening mammogram
  • Radiologic studies and laboratory evaluation only if abnormal history or physical examination
  • Continue screening for other malignancies

Note: Prior chemotherapy may cause lower WBC, higher MCV/MCH. Prior radiation may cause lung infiltration. Prior radiation may alter color/consistency of breast. Refer to physical therapy (if CT chest is negative) if lymphedema of arm occurs.

Metastatic Disease:

  • No further need for mammography
  • Stop screening for other malignancies if life expectancy < 5 years





  Date Updated: 05-JAN-2005

Akron General Medical Center • 400 Wabash Avenue • Akron, OH 44307 • 330-344-6000 • 1-800-221-4601    © 2009 Akron General Health System

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