Description
Determines whether a patient is eligible for routine breast cancer screening. This includes absolute exclusion criteria for which routine screening is not indicated in all guidelines and pathways.
Individuals who have certain signs or symptoms concerning for breast cancer or other breast diseases are excluded from routine screening pathways and should have diagnostic testing performed.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Age 18 years and older | Even for high risk individuals, routine clinical monitoring or screening is not recommended prior to age 21 y and risk reduction modalities are generally not offered at this age. Source: NCCN |
Patient age >= 18 | |
Assigned female at birth or Transgender male | Implemented guidelines address persons assigned female at birth, however there are specialty guidelines that address routine screening for transgender individuals. |
Exclusions
None.
Events
| Name | Description |
|---|---|
Assigned female at birth? | Referenced guidelines apply to individuals assigned female at birth. Routine screening of cis-gender individuals assigned male at birth is not recommended. For transgender women, consider specialist referral. Additional resources: ACR Appropriateness Criteria® Transgender Breast Cancer Screening; UCSF guidelines 'Screening for breast cancer in transgender women' |
'Assigned female at birth' is TRUE | |
Current breast cancer? | Diagnosis of breast cancer within past 5 years |
'Current breast cancer' is TRUE AND onset within 5 years OR 'Previous breast cancer' is TRUE AND onset within 5 years | |
Past bilateral mastectomy? | Excludes breast reduction. |
'History of bilateral mastectomy' is TRUE | |
New or worsening breast disease symptoms? | Excludes past breast symptoms which have since resolved, and chronic, stable breast symptoms for which diagnostic testing was done and found to be benign. Cyclical unilateral or bilateral breast pain at any age and noncyclical diffuse unilateral or bilateral pain in age < 40 years are unlikely to represent malignancy and can continue with routine screening in the absence of other concerning factors (source: ACR). |
Current 'Breast symptoms' exist which are new onset or progressively worsening | |
New or worsening breast exam findings? | Excludes past breast exam findings which have since resolved, and chronic, stable breast findings for which diagnostic testing was done and found to be benign unless further diagnostic testing is recommended by specialist. |
Current 'Breast exam findings' exist which are new onset or progressively worsening | |
Actions
Obtain diagnostic testing Description New breast symptoms or exam findings, or chronic symptoms or findings which have progressively worsened, should undergo diagnostic testing rather than routine screening. Pseudocode |
Refer to Oncologic care plan Description Breast cancer diagnosed 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 |
Patient is eligible for screening Description Pseudocode |