Description
Patient population that have been identified as higher than average risk or otherwise requiring specific consideration within a particular guideline. Provides criteria to determine age to start, screening modality, and screening interval for these populations of patients.
Mid-Level Flow
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
None.
Events
| Name | Description |
|---|---|
Patient population | |
Population to which the patient fits criteria | |
Age group | |
Patient age group | |
Source | |
Source of recommendation | |
Lifetime risk of breast cancer > 20% or 25% | |
First degree relative with genetic marker or syndrome | |
BI-RADS breast density category C or D? | |
Compelling family history of breast cancer | Pedigree of blood relatives on both maternal and paternal side includes compelling history of breast cancer. |
'Compelling family history of breast cancer' is true | |
<30 | |
Patient age < 30 years | |
30-39 | |
Patient age >= 30 and <=39 | |
>=40 | |
Patient age >=40 | |
<40 | |
Patient age < 40 years | |
ACS | |
Source of recommendation is ACS | |
USPSTF | |
Source of recommendation is USPSTF | |
NCCN | |
Source of recommendation is NCCN | |
Actions
Start screening at 30 years old Description Source: ACS Pseudocode Next due date = date patient is 30 years old |
Start screening at 40 years old Description Source: USPSTF Pseudocode Next due date = date patient is 40 years old |
Annual screening mammogram Description Source: ACS Women who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. Pseudocode Screening age = >= 30 Screening modality = mammography Screening interval = annual Next due date = 'Date of last mammography' plus 1 year OR Now if 'Last mammography' does not exist |
Annual screening MRI Description Source: ACS Women who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. Pseudocode Screening age = >= 30 Screening modality = MRI Screening interval = annual Next due date = 'Date of last MRI' plus 1 year OR Now if 'Last MRI' does not exist |
Annual screening mammogram only 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 of last mammography' plus 1 year OR Now if 'Last mammography' does not exist |
Biennial screening mammogram Description Source: USPSTF Pseudocode Screening age = >= 40 Screening modality = mammography Screening interval = biennial Next due date = 'Date of last mammography' plus 2 years OR Now if 'Last mammography' does not exist |
Perform lifetime risk assessment Description Perform assessment of lifetime risk, as defined by models largely dependent on family history. Result of risk assessment informs next step, either proceed to recommendations for Lifetime risk of breast cancer > 20% or 25% or else patient does not meet criteria for special populations. Validated tools include BRCAPRO, Claus, BOADICEA [Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm], and Tyrer-Cuzick. Source: ACS Pseudocode Perform assessment of lifetime risk, as defined by models largely dependent on family history. |