| Name | Description |
|---|---|
Assigned female at birth | Cisgender women and all other persons assigned female at birth (including transgender men and nonbinary persons). |
Sex assigned at birth = female OR Sex assigned at birth missing or unknown AND administrative gender = female OR gender identity = transgender male | |
Current breast cancer | Currently diagnosed with invasive or non-invasive breast cancer without having achieved remission. |
CONDITIONS include `BREAST CANCER` with status active | |
History of bilateral mastectomy | Past history of bilateral mastectomy or unilateral mastectomy on both sides. |
CONDITIONS include `BILATERAL MASTECTOMY` OR PROCEDURES include `BILATERAL MASTECTOMY PROCEDURE` OR (CONDITIONS include `LEFT UNILATERAL MASTECTOMY` OR PROCEDURES include `LEFT UNILATERAL MASTECTOMY PROCEDURE` AND CONDITIONS include `RIGHT UNILATERAL MASTECTOMY` OR PROCEDURES include `RIGHT UNILATERAL MASTECTOMY PROCEDURE` | |
Breast symptoms | Patient reported symptoms concerning for breast disease. |
REVIEW OF SYMPTOMS include `BREAST-RELATED SIGNS OR SYMPTOMS` | |
Breast exam findings | Physical exam findings concerning for breast disease. |
PHYSICAL EXAM OBSERVATIONS include `BREAST-RELATED SIGNS OR SYMPTOMS` | |
Patient eligible for screening | Patient determined to be eligible for screening. |
See 'Screening Eligible' flow logic | |
Genetic marker or syndrome associated with a high risk of breast cancer | Genetic marker or syndrome associated with a high risk of breast cancer (e.g., BRCA1 or BRCA2 genetic variation). |
CONDITIONS include `GENETIC SUSCEPTIBILITY FOR BREAST CANCER` with status active OR Structured documentation of `GENETIC MARKER OR SYNDROME` | |
Genetic marker or syndrome associated with a high risk of breast cancer as defined by ACS | ACS defined genetic marker or syndrome associated with a high risk of breast cancer, including BRCA1 or BRCA2, Li-Fraumeni syndrome (TP53 gene), Cowden or Bannayan-Riley-Ruvalcaba syndrome (PTEN gene) |
CONDITIONS include `BRCA-1 MUTATION CONDITION` OR CONDITIONS include `BRCA-2 MUTATION CONDITION` OR CONDITIONS include `LI-FRAUMENI SYNDROME` OR CONDITIONS include `COWDEN SYNDROME` OR CONDITIONS include `BANNAYAN-RILEY-RUVALCABA SYNDROME` | |
Untested first-degree relative of BRCA carrier | First-degree relative of BRCA carrier, but untested |
FAMILY HISTORY of brca1 or brca2 in first degree relative, including parent or child | |
First-degree relative of Li-Fraumeni syndrome, Cowden or Bannayan-Riley-Ruvalcaba syndrome | First degree relative with Li-Fraumeni syndrome (TP53 gene), Cowden or Bannayan-Riley-Ruvalcaba syndrome (PTEN gene) |
FAMILY HISTORY of Li-Fraumeni syndrome, Cowden or Bannayan-Riley-Ruvalcaba syndrome in first degree relative, including parent or child | |
History of high-dose radiation therapy to the chest | History of high-dose radiation therapy to the chest at a young age. |
CONDITIONS include `CHEST RADIOTHERAPY` with age of onset <= 30 years | |
Previous breast cancer | Past history of invasive or non-invasive breast cancer, with remission. |
CONDITIONS include `BREAST CANCER` with status inactive, resolved, remission OR CONDITIONS include `PREVIOUS BREAST CANCER` with status active | |
High-risk benign breast lesion on previous biopsies | Past high-risk benign histology on breast biopsy at any time. Includes Atypical ductal hyperplasia (ADH) and lobular neoplasia (lobular carcinoma in situ [LCIS]/atypical lobular hyperplasia [ALH]). |
CONDITIONS or DIAGNOSIS CODES include `ATYPICAL HYPERPLASIA`, `ATYPICAL DUCTAL HYPERPLASIA`, `ATYPICAL LOBULAR HYPERPLASIA`, `LOBULAR CARCINOMA IN SITU` OR PATHOLOGY REPORT of type `BREAST BIOPSY` includes narrative documentation of pre-malignant or high-risk lesions | |
Lifetime risk of breast cancer > 20% or 25% | Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history |
Risk assessment using a formal risk assessment tool based mainly on family history is >20% lifetime risk OR Risk assessment without using a formal tool is estimated >20% lifetime risk | |
BI-RADS breast density category C or D | Heterogeneously or extremely dense breast on mammography |
BI-RADS breast density category of 'Last mammography', as reported in DIAGNOSTIC REPORT or documented in a structured form | |
Indicators of reduced life expectancy | Criteria that may indicate reduced life expectancy. |
Patient receiving Hospice Services | Hospice services used by patient during the measurement period. |
CONDITIONS or ENCOUNTER DIAGNOSES include codes from `HOSPICE INTERVENTION` OR `HOSPICE ENCOUNTER` | |
Patient receiving Palliative Care Services | Palliative care services used by patient during the measurement period. |
CONDITIONS or ENCOUNTER DIAGNOSES include codes from `PALLIATIVE INTERVENTION` OR `PALLIATIVE ENCOUNTER` | |
Patient age 66 or older in Institutional Special Needs Plans or residing in long-term care facility | Patients age 66 or older in Institutional Special Needs Plans (SNP) or residing in long term care with POS code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period. |
AGE >= 66 years AND ENCOUNTER DIAGNOSES with POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days | |
Patient with Frailty AND Medication for Dementia | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period. |
AGE >= 66 years AND >= 1 ENCOUNTER DIAGNOSES include `CODES TO IDENTIFY FRAILTY` AND >= 1 MEDICATIONS include `DEMENTIA EXCLUSION MEDICATIONS` with dispense | |
Patient with Frailty AND Advanced Illness | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period. |
AGE >= 66 years AND >= 1 ENCOUNTER DIAGNOSES include `CODES TO IDENTIFY FRAILTY` AND (>= 1 ENCOUNTER of type acute inpatient where DIAGNOSES include `CODES TO IDENTIFY ADVANCED ILLNESS` OR >= 2 ENCOUNTERS of type outpatient, observation, ED or nonacute inpatient where DIAGNOSES include `CODES TO IDENTIFY ADVANCED ILLNESS`) | |
Last mammography | Latest mammography, screening or diagnostic, including film, digital or digital breast tomosynthesis (3D) mammography. Can be determined from presence of radiology report or result documented in a structured form. |
Latest DIAGNOSTIC REPORT of type `SCREENING MAMMOGRAPHY` OR `DIAGNOSTIC MAMMOGRAPHY` OR Documented result of latest `SCREENING MAMMOGRAPHY` OR `DIAGNOSTIC MAMMOGRAPHY`. | |
Date of last mammography | Date of latest mammography. |
Study date of 'Last mammography' | |
Last mammography result | |
BI-RADS score of 'Last mammography', as reported in DIAGNOSTIC REPORT or documented in a structured form | |
Pending mammography | Patient has an active mammography order or referral. |
Most recent ORDER or REFERRAL with exam code `SCREENING MAMMOGRAPHY` AND status is active | |
Last MRI | Latest MRI, screening or diagnostic. Can be determined from presence of radiology report or result documented in a structured form. |
Latest DIAGNOSTIC REPORT of type `SCREENING MRI` OR Documented result of latest `SCREENING MRI` as BI-RADS score. | |
Date of last MRI | Date of latest MRI. |
Study date of 'Last MRI' | |
Last MRI result | |
BI-RADS score of 'Last MRI', as reported in DIAGNOSTIC REPORT or documented in a structured form | |
Pending MRI | Patient has an active MRI order or referral. |
Most recent ORDER or REFERRAL with exam code `SCREENING MRI` AND status is active | |
Last ultrasound | Latest US, screening or diagnostic. Can be determined from presence of radiology report or result documented in a structured form. |
Latest DIAGNOSTIC REPORT of type `SCREENING US` OR `DIAGNOSTIC US` OR Documented result of latest `SCREENING US` OR `DIAGNOSTIC US` as BI-RADS score. | |
Date of last ultrasound | Date of latest ultrasound. |
Study date of 'Last ultrasound' | |
Pending ultrasound | Patient has an active MRI order or referral. |
Most recent ORDER or REFERRAL with exam code `SCREENING US` AND status is active | |
Last biopsy | Latest breast biopsy. Can be determined from presence of pathology report or result documented in a structured form. |
Latest DIAGNOSTIC REPORT of type `BREAST BIOPSY` OR Documented result of latest `BREAST BIOPSY` as diagnostic code. | |
Date of last biopsy | Date of latest biopsy. |
Study date of 'Last biopsy' | |
Pending biopsy | Patient has an active biopsy order or referral. |
Most recent ORDER or REFERRAL where exam code is `BREAST BIOPSY PROCEDURE` AND status is active | |
Biopsy result negative | Pathology of breast biopsy has no atypical hyperplasia, LCIS or malignant findings and is not indeterminate or discordant. May have other benign breast conditions. |
'Biopsy result atypical' is FALSE AND 'Biopsy result malignant' is FALSE AND 'Biopsy result indeterminate' is FALSE AND 'Biopsy result discordant' is FALSE | |
Biopsy result atypical | Pathology of breast biopsy has atypical findings. |
Biopsy result includes `ATYPICAL HYPERPLASIA` OR `ATYPICAL DUCTAL HYPERPLASIA` OR `ATYPICAL LOBULAR HYPERPLASIA` OR `LOBULAR CARCINOMA IN SITU` | |
Biopsy result indeterminate | Pathology of breast biopsy has indeterminate findings. |
Biopsy result is `INDETERMINATE HISTOLOGY` | |
Biopsy result discordant | Pathology of breast biopsy has findings discordant with imaging result. |
Biopsy result is 'Biopsy result negative' AND 'Last mammography result' is BI-RADS 5 | |
Biopsy result malignant | Pathology of breast biopsy has malignant findings. |
Biopsy result includes `INVASIVE BREAST CANCER` OR `NON-INVASIVE BREAST CANCER` | |
BRCA-1 mutation test | BRCA-1 mutation diagnostic test, including pathology report |
EXISTS DIAGNOSTIC TEST with type `BRCA-1 MUTATION` | |
BRCA-2 mutation test | BRCA-2 mutation diagnostic test, including pathology report |
EXISTS DIAGNOSTIC TEST with type `BRCA-2 MUTATION` | |
BRCA-1 mutation diagnosis | Known BRCA-1 mutation carrier. |
CONDITIONS include `BRCA-1 MUTATION CONDITION` with status active | |
BRCA-2 mutation diagnosis | Known BRCA-2 mutation carrier. |
CONDITIONS include `BRCA-2 MUTATION CONDITION` with status active | |
Family history of known BRCA1/2 mutation | Family member with known BRCA mutation of any type. |
FAMILY HISTORY includes family member with DIAGNOSIS `BRCA-1 MUTATION CONDITION` OR `BRCA-2 MUTATION CONDITION` | |
Family history of breast cancer | Family history of breast cancer. |
FAMILY HISTORY includes family member with DIAGNOSIS `INVASIVE BREAST CANCER` OR FAMILY HISTORY includes family member with DIAGNOSIS `NON-INVASIVE BREAST CANCER` | |
Family history of ovarian cancer | Family history of ovarian cancer. |
FAMILY HISTORY includes family member with DIAGNOSIS `OVARIAN CANCER` | |
Family history of tubal cancer | Family history of tubal cancer. |
FAMILY HISTORY includes family member with DIAGNOSIS `TUBAL CANCER` | |
Family history of peritoneal cancer | Family history of peritoneal cancer. |
FAMILY HISTORY includes family member with DIAGNOSIS `PERITONEAL CANCER` | |
'Compelling family history of breast cancer' is true | Pedigree of blood relatives on maternal and/or paternal side includes compelling history of breast cancer. |
Output of validated brief familial risk assessment tool is positive OR 'Informal familial risk criteria' exist | |
Informal familial risk criteria | Criteria in first- or second-degree blood relatives known to be associated with increased risk of inherited breast cancer susceptibility variant. May include criteria such as: 2 or more relatives with breast or ovarian cancer breast cancer occurring before age 50 years a family history of both breast and ovarian cancer one or more relatives with 2 cancers (breast and ovarian cancer or 2 independent breast cancers) male relatives with breast cancer Source: ACS |
FAMILY HISTORY includes >= 2 first- or second- degree relatives with breast cancer OR FAMILY HISTORY includes >= 2 first- or second- degree relatives with ovarian cancer OR FAMILY HISTORY includes >= 1 first- or second- degree relatives with breast cancer diagnosed <= 50 years old OR FAMILY HISTORY includes at least one first- or second- degree relative with breast AND at least one relative wth ovarian cancer OR FAMILY HISTORY includes >= 1 first- or second- degree relative with both breast and ovarian cancer OR FAMILY HISTORY includes >= 1 first- or second- degree relative with 2 independent breast cancers OR FAMILY HISTORY includes >= 1 first- or second- degree male relative with breast cancer | |