3. Screening/Early Detection Updated 24 August 2009 About one in nine women living to age ninety will eventually be diagnosed as having breast cancer. Mammography for screening should be directed towards women at high risk. Risk increases with advancing age and the following screening procedures are recommended for women over forty years of age. The criteria to estimate the level of risk for women under age forty are described in below. These women require individualized assessment of risk and benefit from Hereditary Cancer Program.�� High Risk Groups in Women Under Age Forty A woman with two or more first-degree relatives with premenopausal or bilateral breast cancer is at particularly high risk and should be referred for genetic counselling and assessment for hereditary cancer. The Hereditary Cancer Program is a joint activity of the B.C. Cancer Agency and the�Provincial Medical Genetics Program. Some families, accounting for perhaps up to 10% of breast cancers, may be carriers of specific genetic mutations. Testing is available for families at risk of mutations in BRCA1 or BRCA2. These women are candidates for programs of special surveillance. Women at high risk should be referred to the Hereditary Cancer Program. A woman with a sister or mother with bilateral breast cancer would be at four-fold risk of breast cancer, if the case were postmenopausal or nine-fold if the case were premenopausal. This person would be at even higher risk if, in addition to the family history, she met any of the following criteria: There was also a family history of ovarian cancer or male breast cancer.� Ashkenazi Jewish heritage. 3.1 Breast Self-examination Women may be encouraged to do regular breast self-examination (BSE). For premenopausal women this is best done in the week following the menstrual period. For postmenopausal women a specific day of the month should be chosen. The examination should include inspection of the breast and palpation of the breast and axilla. To perform adequate BSE the patient needs instruction in the technique and the manner in which she is carrying this out. This should be checked at subsequent examinations by her family physician.There is no evidence that BSE improves survival, but regular self-examination does allow a woman to know her own body and therefore she may recognize changes early. 3.2 Family Physician The combination of physical examination by a physician and mammographic screening has been shown to reduce mortality from breast cancer. The relative importance of the physical examination vis-a-vis the mammogram remains unclear. It is recommended that all women over the age of 20 years receive an annual physical examination of the breasts by their family physician both as a screening procedure and as an opportunity to teach breast self-examination. Ten percent of breast cancers will not show up on a mammogram in older women, but as many as 25-30% of breast cancers are not seen on screening mammograms in women age 40 to 49. 3.3 Screening Mammography Screening Mammography Program of B.C. (SMPBC) Recruitment & Recall Policies Basic Eligibility Criteria: 40-79 years of age� resident of B.C.� no breast problems� no mammogram in last 12 months� has a family doctor� no previous history of breast cancer� no breast implants� not pregnant or breast feeding SMPBC Recommendations: AGE SELF-REFERRAL SMPBC WILL SEND YOU A RECALL LETTER 40-49 yes every 12- 18 months 50-79 yes every 2 years* � � � 80+ no will accept with family physician referral � *a reminder letter will be sent if no visit/appointment is made 4-6 weeks after the recall letter is sent. � Age
Posted on: Tue, 08 Oct 2013 21:58:07 +0000
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