Description
Clinical characteristics that have been identified in the USPSTF breast screening recommendation statement as indicative of higher than average risk and therefore excluded from recommendation statement patient population. Provides criteria to determine age to start and age to stop, screening modality, and screening interval for these populations of patients.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
| Name | Description |
|---|---|
Patient is not eligible for screening | |
See 'Screening Eligible' flow logic | |
Events
| Name | Description |
|---|---|
Genetic marker or syndrome? | |
History of chest radiation ages 10-30 y? | Thoracic radiation therapy between ages 10 and 30 years |
'History of high-dose radiation therapy to the chest' with age at treatment start >= 10 years and <= 30 years OR age at treatment end >= 10 years and <= 30 years | |
Age >= 25 and >= 8 y after RT? | Patient age is 25 years or older and currently is >= 8 years after RT completion |
Patient age >= 25 years AND >= 8 years after completion of 'History of high-dose radiation therapy to the chest' | |
Previous breast cancer? | History of invasive or non-invasive breast cancer. |
'Previous breast cancer' is TRUE | |
In remission < 5 y? | Breast cancer in remission < 5 years duration? |
'Previous breast cancer' is TRUE AND end date < 5 years ago | |
Previous atypical biopsy? | High risk benign histology on past breast biopsy, including ADH, ALH and LCIS. |
Lifetime risk of breast cancer > 20% or 25% | Estimated lifetime risk is >20%, based on informal assessment or assessment using validated risk model |
BRCA1/2, Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba? | History of known BRCA1/2 variants, Li-Fraumeni syndrome (TP53 variant), Cowden or Bannayan-Riley-Ruvalcaba syndromes (PTEN variants). |
Actions
Refer to specialist recommendations Description A number of other genetic variants are known to be associated with an increased risk of developing of breast cancer. For known personal history of these variants, refer to the consulting geneticist or to high risk breast specialist for guidance on routine screening. Variants may include ATM, BARD1, CDH1, CHEK2, NF1, PALB2, RAD51C, RAD51D, STK11. Pseudocode |
Annual screening mammogram starting age 30 Description Source: ACS Women who are at higher than average risk for breast cancer based on certain factors should get a mammogram every year, typically starting at age 30. Pseudocode Screening age = >= 30 Screening modality = mammography Screening interval = annual Next due date = date patient is 30 years old if age < 30 OR Next due date = 'Date of last mammography' plus 1 year OR Now if 'Last mammography' does not exist |
Annual screening MRI starting age 30 Description Source: ACS Women who are at higher than average risk for breast cancer based on certain factors should get a breast MRI every year, typically starting at age 30. Pseudocode Screening age = >= 30 Screening modality = mri Screening interval = annual Next due date = date patient is 30 years old if age < 30 OR Next due date = 'Date of last MRI' plus 1 year, if exists OR Next due date = 'Date of last mammography' plus 1 year, if exists OR Next due date = Now if 'Last MRI' and 'Last mammography' do not exist |
Annual screening mammogram starting age 30 Description Source: ACS Women who are at high risk for breast cancer based on certain factors should get a mammogram every year, typically starting at age 30. There’s not enough evidence to make a recommendation for or against yearly MRI screening for women who have a higher lifetime risk based on certain factors. Pseudocode Screening age = >= 30 Screening modality = mammography Screening interval = annual Next due date = date patient is 30 years old if age < 30 OR Next due date = 'Date of last mammography' plus 1 year OR Next due date = Now if 'Last mammography' does not exist |
Start screening after age 25 years and >= 8 y after RT Description Start at age 25 years or >= 8 years from radiation, whichever occurs last. Source: ACR, NCCN Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance. Pseudocode Next due date = latest of date patient is 25 years old or date of >= 8 years after completion of RT |
Refer to Oncologic care plan Description Previous breast cancer within 5 years may require enhanced surveillance including diagnostic mammogram. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance. Pseudocode Next due date = refer to Oncologic care plan |
No exclusions for USPSTF screening pathway Description Patient does not meet exclusion criteria for USPSTF average risk breast cancer screening recommendations. Pseudocode |