In this post I link to and excerpt from one of the best medical podcasts I’ve listened from The Curbsiders, September 28, 2020 by Dr. Nora Tarantano, #234 THE BREAST LUMP, AND BREAST CANCER SCREENING:
Master your breast cancer screening spiel, cultivate your approach to the breast mass, and empower your patients with empathetic shared decision-making (which we know you’re all already fabulous at)! On this fantastic episode, we are joined by Dr. Nancy Keating @NancyKeatingMD, policy wonk and primary care doc extraordinaire at Brigham and Women’s Hospital. This episode is rife with drama, as the ACS butts heads with the USPSTF and the ACR, and you have to figure out what’s right for the patient by talking with them–almost as exciting as that moment on Grey’s when Izzie cuts the…anyway, I won’t ruin a key plot point in the most excellent medical show of all time, all in a day’s work, here at The Curbsiders. Enjoy!
Here is the podcast:
And here are excerpts:
Breast Lumps and Cancer Screening Pearls
- Malignancy causes a minority of palpated breast masses, but is important to rule out, especially as women age.
- Perform a clinical breast exam for any breast complaint (even though there’s mixed evidence for its utility in screening)
- Evaluate the breast lump initially with ultrasound in women younger than 30, and with both diagnostic mammogram and ultrasound in women thirty or older. You may need to follow up with an aspiration or core needle biopsy, depending on the results.
- In some patients (younger, few risk factors, no red flags on exam), it’s appropriate to observe and re-evaluate in several months if imaging does not reveal a mass.
- To decide when to start screening: Use the National Cancer Institute, Breast Cancer Surveillance Consortium (BCSC) Risk Calculator, taking into account Individual Risk factors, to assess whether patients are average or high risk for the development of breast cancer.
- Mammogram Screening Recommendations for average risk women differ from society to society. The ACS recommends yearly from age 45 to 54 and every other year starting at age 55. The USPSTF recommends mammography every other year from 50-75.
- The harms of mammogram include false positives and unnecessary testing, overdiagnosis of disease that is not and would not become clinically significant, and anxiety about having a diagnosis of cancer that proves to be unfounded.
- Engage in shared decision-making with your patients to decide when to start screening mammography, and when to stop.
- Consider stopping mammography screening when the patient has less than 10 estimated life years (use ePrognosis).