ClinicalSlideSet.BreastCancerScreeningandPrevention.pptVIP

Clinical Bottom Line: Risk Assessment... Breast cancer is common among U.S. women and increases with age. Other factors that increase this risk include the duration of endogenous estrogen (which can be approximated by the age of menopause), breast density, proliferative breast disease, and family history. Genetic mutations are uncommon but increase risk substantially. Online calculators can help assess risk. We recommend that clinicians conduct a periodic risk assessment, including collection of family history at least every 5 years as a first step in mitigating high risk and to develop an individualized screening plan. * Who should be screened for breast cancer? Since many women who develop breast cancer do not fall into a clear high-risk group and because of the strong connection between age and risk of breast cancer, a consensus has emerged that women should undergo screening for breast cancer using primarily age-based protocols. High-risk women may benefit from modifications of these protocols. No low-risk groups (other than young age) have been identified in which screening can clearly be omitted. * Is breast cancer screening effective in reducing mortality? Eight large randomized trials (sometimes broken into 9–11 separate components) have studied mammography screening in the general population, including about 600 000 women from the United States, Canada, United Kingdom, and Sweden. These studies were somewhat heterogeneous with regard to the age groups included, methods of randomization, intervals between screening, and methods of analysis. Nonetheless, meta-analyses have shown that when compared with controls, groups offered screening had a 15%–20% reduction in risk for breast cancer mortality among all age groups (6, 17). For women aged 40–59 years, the reduction in was smaller in magnitude and less statistically significant (Table 3) (17). For women aged 60–69 years, the reduction was highly significant. For women aged 70–74 years, the reduction was not