CDC Breast Cancer Screening CDS L2
Introduction
Introduction
This document includes a semi-structured representation of evidence-based narrative guidelines for breast cancer screening. Semi-structured representation, also known as Level 2 representation, of guideline content and recommendations is essential for the development of computable clinical decision support (CDS) artifacts. It includes:
- High-level and mid-level flow diagrams that visually illustrate portions of the guidelines.
- A brief description of each portion of the CDS logic.
- Semi-structured logic statements that list required clinical concepts, inclusion criteria, exclusion criteria, events (decision points), and actions (output, e.g. recommendations).
How to Navigate the Specification
Start with Pathway. This page includes:
- High-level flow diagram, which visually illustrates the main logic paths translated, applicable guidelines, and order of precedence and dependencies among logic paths.
- A combined view of mid-level flow diagrams, which provide a more detailed view of each logic path and how they relate to each other.
Each logic path has a dedicated page under Logic Paths, which includes the mid-level flow diagram for the path, as well as semi-structured logic statements. These may refer to:
- Data elements: logic statements used multiple times across the specification; and
- Terminology: clinical concepts that will eventually be represented by lists of codes.
Pathway
The high-level flow diagram identifies several different patient populations based on a patient’s symptoms, past medical history and previous screening results. The flow diagram also points to the corresponding guidelines that outline how that patient should be cared for. The mid-level flow diagram (which is divided across several pages) provides a more detailed view of the logic. It describes how population criteria are defined and decision points that identify relevant guidelines and patient-specific recommendations.
High-Level Flow Diagram
In certain clinical scenarios, portions of the relevant National Comprehensive Cancer Network® (NCCN®) guidelines listed below were referenced. These are in select use cases where the primary guidelines did not provide specific or actionable criteria for patient stratification rather than for guidance or recommendations.
National Comprehensive Cancer Network. Breast Cancer Screening and Diagnosis (Version 2.2023).
National Comprehensive Cancer Network. Breast Cancer Risk Reduction (Version 1.2024).
National Comprehensive Cancer Network. Breast, Ovarian, and/or Pancreatic Cancer Genetic Assessment (Version 2.2024).
Mid-level flow diagrams
Screening Decision Mid-level Flow
Care Delivery and Follow-up Mid-Level Flow
Logic Paths
Semi-structured logic statements are comprised of three “sections” or components, each with a distinct purpose:
- Inclusion - describes target population criteria
- Exclusion - removes individuals from the target population based on evidence-based recommendations
- CDS Events - describes a decision point or trigger in the logic that leads to a recommendation or action
- CDS Actions - describes one or more “products” (e.g., calculations, recommendations) that the logic provides for a patient that meets the inclusion criteria, is not removed by the exclusion criteria, and meets the event criteria
Screening Eligible
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 |
Decision to Screen
Description
Evaluate criteria to determine age to start and age to stop, screening modality, and screening interval.
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 |
|---|---|
Age > 74? | Age > 74 years |
Patient age > 74 years | |
Indicators of reduced life expectancy? | Patient has conditions or meets criteria that indicate reduced life expectancy. |
Currently lactating? | Patient is currently lactating or breast feeding. |
OBSERVATIONS include `Lactating or Breastfeeding` | |
High risk exclusions or special population? | Patient meets criteria for patient population excluded from USPSTF recommendation statement or meets criteria for patient population identified as having higher than average risk in ACS guidelines. |
Actions
Discuss decision to continue screening Description The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older. Decision to continue screening mammography in average risk women should be based on shared decision-making. Pseudocode |
Discuss decision to continue screening if life expectancy < 10 years Description ACS advises that women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more. Life expectancy is generally defined as having greater than a 50% probability of surviving 10 years. A validated tool such as www.eprognosis.com can help guide decision making. Decision to continue screening mammography in cases of limited life expectancy should be based on shared decision-making. Pseudocode |
High risk exclusion recommendations Description Evaluate for high risk exclusion criteria Pseudocode See 'High Risk Exclusions' flow logic |
Special population recommendations Description Evaluate for special population criteria Pseudocode See 'Special Populations' flow logic |
Consider delay if average risk Description There is no contraindication to screening mammography during lactation, however sensitivity and specificity are decreased. For average risk patients, consider a short delay in routine breast imaging until after lactation, particularly if they are not planning prolonged breastfeeding. Source: NCCN Pseudocode |
Average Risk recommendations Description Evaluate for average risk criteria Pseudocode See 'Average Risk' flow logic |
High Risk Exclusions
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 |
Special Populations
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. |
Average Risk
Description
Patient population identified as average risk. Provides criteria to determine age to start, screening modality, and screening interval for these populations of patients.
Clinical Review
Mid-Level Flow
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
None.
Events
| Name |
|---|
Age group |
Patient age group |
Source |
Source of recommendation |
<40 |
Patient age < 40 years |
40-44 |
Patient age >=40 and <=44 |
45-54 |
Patient age >=45 and <=54 |
>=55 |
Patient age >=55 |
ACS |
Source of recommendation is ACS |
USPSTF |
Source of recommendation is USPSTF |
Actions
Start screening at 40 years old Description Source: USPSTF Pseudocode Next due date = date patient is 40 years old |
Offer annual screening mammogram Description Source: ACS Women between 40 and 44 have the option to start screening with a mammogram every year. Pseudocode Screening age = >= 40 and <44 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 mammogram Description Source: ACS Women 45 to 54 should get mammograms every year. Pseudocode Screening age = >= 45 and <54 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 or continue screening annually Description Source: ACS Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years. Pseudocode Screening age = >= 55 Screening modality = mammography Screening interval = biennial OR annual Next due date = 'Date of last mammography' plus 1 or 2 years OR Now if 'Last mammography' does not exist |
Biennial screening mammogram Description 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 |
Genetic Risk Referral
Description
Risk assessment for women who have family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes to determine who should receive referral for genetic counseling and, if indicated after counseling, testing.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Age 18 years and older | In children <18 y, genetic testing is generally not recommended when results would not impact medical management. Source: NCCN |
Patient age >= 18 | |
Assigned female at birth | Referenced guidelines apply to individuals assigned female at birth. For transgender women, refer to specialty guidelines. |
'Assigned female at birth' is TRUE | |
Exclusions
| Name | Description |
|---|---|
Patient is not eligible for screening | |
See 'Screening Eligible' flow logic | |
Events
| Name | Description |
|---|---|
Family history of inherited cancer susceptibility? | Any blood relative with known BRCA1/BRCA2 variants, Li-Fraumeni syndrome (TP53 variant), Cowden or Bannayan-Riley-Ruvalcaba syndromes (PTEN variants), and other variants known to be associated with increased risk of development of breast cancer. Variants may include ATM, BARD1, CDH1, CHEK2, NF1, PALB2, RAD51C, RAD51D, STK11. |
Unknown variant status? | Not previously tested for BRCA1/BRCA2 variants or other variant of concern based on known family history. |
DOES NOT EXIST 'BRCA-1 mutation diagnosis' OR 'BRCA-2 mutation diagnosis' OR 'BRCA-1 mutation test' OR 'BRCA-2 mutation test' OR DOES NOT EXIST prior genetic testing panel including variant of concern | |
Family history of breast, ovarian, tubal, or peritoneal cancer | Pedigree of blood relatives on both maternal and paternal side including asking about specific types of cancer, primary cancer sites, which family members were affected, whether relatives had multiple types of primary cancer, age at diagnosis, age at death, and sex of affected family members. |
Ancestry associated with BRCA1/2 gene mutations? | Can offer testing to individuals who have one grandparent identified as of Ashkenazi Jewish ancestry, irrespective of cancer history in the family and without additional risk factors (source: NCCN). |
Ashkenazi Jewish ancestry in at least one grandparent | |
Selected method for familial risk assessment | Method by which to perform assessment of risk of inherited variant associated with breast cancer susceptibility |
FORMAL OR INFORMAL | |
Family history risk assessment result? | Result of familial risk assessment, either formal using a validated risk tool or informal using clinician judgement |
Output of validated brief familial risk assessment tool is positive, as defined by tool itself OR Probability >5% of a BRCA1/2 P/LP variant based on prior probability models, if model does not provide cutoff OR Informal familial risk assessment suggestive of higher than average risk of genetic variant | |
Actions
Brief familial risk assessment tool Description Tools evaluated by the USPSTF include the Ontario Family History Assessment Tool, Manchester Scoring System, Referral Screening Tool, Pedigree Assessment Tool, 7-Question Family History Screening Tool, International Breast Cancer Intervention Study instrument (Tyrer-Cuzick), and brief versions of BRCAPRO. Source: USPSTF Pseudocode |
Informal familial risk assessment Description Perform assessment based on criteria in first- or second-degree blood relatives known to be associated with increased risk of inherited breast cancer susceptibility variant. Source: ACS Pseudocode |
Referral for genetic counseling Description Referral for genetic counseling if not previously consulted, or if limited panel was done and additional testing may be warranted. Source: USPSTF Pseudocode REFERRAL for genetic counseling |
High Risk Referral
Description
Women who are at increased risk for breast cancer without current or previous diagnosis of breast cancer or ductal carcinoma in situ (DCIS) can be referred to a breast specialty clinic to consider risk reduction interventions.
Mid-Level Flow
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 | Referenced guidelines apply to individuals assigned female at birth. For transgender women, refer to specialty guidelines. |
'Assigned female at birth' is TRUE | |
Exclusions
| Name | Description |
|---|---|
Patient is not eligible for screening | |
See 'Screening Eligible' flow logic | |
Previous diagnosis of breast cancer | No indication for primary risk reduction in patient with breast cancer in remission. Secondary risk reduction would be determined by Oncologic team. |
'Previous breast cancer' is TRUE | |
Events
| Name | Description |
|---|---|
Patient population | |
Population to which the patient fits criteria | |
Age group | |
Patient age group | |
Any | |
Any age | |
>= 35 | |
Patient age >= 35 years | |
Genetic marker or syndrome | |
History of chest radiation | |
Previous high-risk finding on biopsy | High-risk benign pathology on previous breast biopsy, particularly ADH, LCIS, ALH. |
5 year risk >= 3% | Estimated 5 year risk of breast cancer, either performed using formal assessment model or informal assessment, is >= 3% |
Formal clinical risk assessment tool output suggests 5 year risk >= 3% OR assessment of breast cancer risk factors without using a formal tool suggests higher than average risk | |
5 year risk >= 1.67% | Estimated 5 year risk of breast cancer, either performed using formal assessment model or informal assessment, is >= 1.67% |
Formal clinical risk assessment tool output suggests 5 year risk >= 1.67% OR assessment of breast cancer risk factors without using a formal tool suggests higher than average risk | |
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 | |
Personal risk factors conferring increased risk of breast cancer | Patient has risk factors that contribute to risk of developing breast cancer. These may include increasing age, younger age at menarche, older age at first live birth, nulliparity/lower parity, number of prior breast biopsies, heterogeneously and/or extremely dense breasts. |
EXISTS > 1 DIAGNOSTIC REPORT of type `BREAST BIOPSY` OR BI-RADS breast density score in 'Last mammography result' is C OR D | |
Actions
Consider life expectancy Description Patient may not be a candidate for chemoprevention if estimated life expectancy is < 10 years. Factors that may impact this estimation should be considered prior to referral. A validated tool such as www.eprognosis.com can help guide decision making. Pseudocode |
Referral for high risk breast specialty evaluation Description Consider referral to breast specialist to discuss primary risk reduction interventions such as chemoprevention. Women at greater risk, such as those with at least a 3% risk for breast cancer in the next 5 years, are likely to derive more benefit than harm from risk-reducing medications. Source: USPSTF Pseudocode REFERRAL for high risk breast clinic evaluation if none previously |
Consider referral for high risk breast specialty evaluation Description Consider referral to breast specialist to discuss primary risk reduction interventions such as chemoprevention. Source: USPSTF Pseudocode REFERRAL for high risk breast clinic evaluation if none previously |
Perform risk assessment Description The NCI Breast Cancer Risk Assessment Tool and the Breast Cancer Surveillance Consortium Risk Calculator are based on models tested in US populations and are publicly available for clinicians and patients to use as part of the process of shared, informed decision-making about taking risk-reducing medications for breast cancer. Source: USPSTF Pseudocode Perform risk assessment using a formal clinical risk assessment tool OR Perform assessment of breast cancer risk factors without using a formal tool |
Due for Screening
Description
Identifies patient who may be due for screening based on prior assessment and documentation of next due date and flags patient who may be overdue for potential enhanced outreach efforts.
Intended for use with either individual patient alerts, within the context of a clinical encounter or outside an encounter, or for generating asynchronous reports on a cohort/panel of patients in order to target outreach or escalation.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
None.
Events
| Name | Description |
|---|---|
Next due date is available? | Documented next due date, based on output of previous pathways. |
EXISTS next due date | |
Age 40-74 without screening in past 27 months? | No screening mammography within past 27 months in patient 40–74 years of age |
Age is >= 40 AND age is <=74 AND ('Last mammography' does not exist OR 'Last mammography' date is > 27 months ago) | |
Selected interval for screening? | Documented interval for screening based on output of previous pathways, if available. |
ANNUAL if preferred interval is annual OR BIENNIAL if preferred interval is biennial OR UNKNOWN if not documented | |
Due for screening? | Refer to next due date, which is the output of previous pathways involving assessment of patient history and risk factors, to determine whether patient is currently due for screening study, overdue or not yet due. |
OVERDUE if next due date > 3 months OR DUE if next due date within 2 months from now OR < 3 months ago OR Otherwise NOT DUE | |
Due for biennial screening? | Refer to next due date, which is the output of previous pathways involving assessment of patient history and risk factors, to determine whether patient is currently due for screening study, overdue or not yet due. |
OVERDUE if next due date > 3 months OR DUE if next due date within 2 months from now OR < 3 months ago OR Otherwise NOT DUE | |
Due for annual screening? | Refer to next due date, which is the output of previous pathways involving assessment of patient history and risk factors, to determine whether patient is currently due for screening study, overdue or not yet due. |
OVERDUE if next due date > 2 months OR DUE if next due date within 2 months from now OR < 2 months ago OR Otherwise NOT DUE | |
Actions
Determine next due date Description Determine whether patient is eligible for screening and if so, document next due date Pseudocode See 'Decision to Screen' flow logic |
Flag overdue Description Flag patient as overdue for routine screening to allow clinician alert or patient outreach Pseudocode |
Order screening mammogram Description Order screening mammography Pseudocode ORDER for screening mammography if 'Pending mammography' does not exist |
Order screening MRI if eligible Description Order screening MRI as determined by prior assessment of patient eligibility for supplemental screening Pseudocode ORDER for screening MRI if 'Pending MRI' does not exist AND patient is eligible for MRI |
Screening Test Incomplete
Description
Identifies patients who have been ordered for screening mammography or for follow-up study for abnormal screening mammography but for whom a study report has not been received or documented as received.
Intended for use with either individual patient alerts, within the context of a clinical encounter or outside an encounter, or for generating asynchronous reports on a cohort/panel of patients in order to target outreach or escalation.
Mid-Level Flow
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Primary screening ordered | |
See 'Screening due' flow logic | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Patient population | |
Population to which the patient fits criteria | |
Last mammogram result is BI-RADS 0? | Awaiting final amended imaging report, either due to need for further imaging or comparison with previous mammography to verify stability of a finding. |
BI-RADS score in 'Last mammography result' is 0, recall to imaging center | |
Pending mammography order without subsequent report? | |
'Pending mammography' exists AND 'Date of last mammography' does not exists OR is before date 'Pending mammography' order or referral was placed | |
Pending MRI order without subsequent report? | |
'Pending MRI' exists AND 'Date of last MRI' does not exists OR is before date 'Pending MRI' order or referral was placed | |
Pending ultrasound order without subsequent report? | |
'Pending ultrasound' exists AND 'Date of last ultrasound' does not exists OR is before date 'Pending ultrasound' order or referral was placed | |
Pending biopsy order without subsequent report? | |
'Pending biopsy' exists AND 'Date of last biopsy' does not exists OR is before date 'Pending biopsy' order or referral was placed | |
Pending specialty referral without subsequent consult note? | Patient has an active specialty referral without a subsequent consult note of the same type. |
REFERRAL where service type is `BREAST SURGERY` OR `MEDICAL ONCOLOGY` exists and status is active AND There does not exist a CLINICAL NOTE of service type `BREAST SURGERY` OR ` MEDICAL ONCOLOGY` with date after referral | |
Actions
Pending screening test Description Patient has incomplete screening tests Pseudocode Patient has incomplete screening tests |
Follow-up Screening Result
Description
Determines next steps, if any, based on result of screening imaging or biopsy. This may be triggered by a diagnostic report being received by the system or a mammography BI-RADS result being documented in a structured manner.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
None.
Exclusions
None.
Events
| Name | Description |
|---|---|
Latest screening test type? | |
Actionable BI-RADS? | |
BI-RADS score in most recent resulted test of either 'Last mammography result' OR 'Last MRI result' is NOT 1 or 2 | |
BI-RADS score? | |
BI-RADS score in most recent resulted test of either 'Last mammography result' OR 'Last MRI result' | |
Pathology result? | Result of pathology of last breast tissue biopsy. |
malignant if 'Last biopsy' result is 'Biopsy result malignant' OR atypical if 'Last biopsy' result is 'Biopsy result atypical' OR indeterminate if 'Last biopsy' result is 'Biopsy result indeterminate' OR discordant if 'Last biopsy' result is 'Biopsy result discordant' OR negative if 'Last biopsy' result is 'Biopsy result negative' | |
Actions
Update next due date Description Pseudocode Next due date = 'Date of last mammography' plus 2 years OR Now if 'Last mammography' does not exist |
Order interval imaging Description Refer to Radiology report for patient specific recommendations on follow-up imaging modality and interval Pseudocode |
Referral for biopsy Description Referral for biopsy, either core needle or, if recommended by Radiology, FNA or excisional Pseudocode |
Referral for high risk evaluation Description Pseudocode REFERRAL for high risk breast clinic evaluation |
Referral for excisional biopsy Description Referral for excisional biopsy or else repeat core needle or FNA if recommended by Radiology. Pseudocode |
Referral for excisional biopsy Description Referral for excisional biopsy, in consultation with Radiology. Pseudocode REFERRAL to service type `BREAST SURGERY` |
Specialist referral Description Referral to breast surgery or medical oncology as appropriate Pseudocode |
Data Elements and Terminology
Data elements are logic statements that are used throughout the semi-structured specification to enhance readibility and reduce redundancy of frequently used logic phrases.
Terminology defines sets of clinical concepts and convey the specific distinguishing characteristics of the included member concepts.
Data Elements
| 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 | |
Terminology
Terminology defines sets of clinical concepts and convey the specific distinguishing characteristics of the included member concepts.
- Clinical Focus - A statement describing the general focus of the set, including a description of the intended constituent concepts. This can include information about clinical relevancy or a statement about the general focus of the set.
- Inclusions - A statement that describes what specific concept or code criteria are included and why.
- Exclusions - A statement that describes what specific concept or code criteria would normally be included, but are specifically excluded by the authors, including their rationale for exclusions.
Content
BREAST CANCER Clinical Focus Diagnosis or billing codes for invasive breast cancer Inclusions Invasive and non-invasive forms of breast cancer. Exclusions Cancers affecting skin of breast, Paget's disease. |
BILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of bilateral mastectomy Inclusions Exclusions |
UNILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of unilateral mastectomy with unspecifed laterality. Inclusions Unspecified laterality Exclusions Specified laterality |
LEFT UNILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of left unilateral mastectomy Inclusions Exclusions Unspecified laterality |
RIGHT UNILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of right unilateral mastectomy Inclusions Exclusions Unspecified laterality |
BILATERAL MASTECTOMY PROCEDURE Clinical Focus Procedure codes for bilateral mastectomy Inclusions Exclusions |
LEFT UNILATERAL MASTECTOMY PROCEDURE Clinical Focus Procedure codes for left unilateral mastectomy Inclusions Exclusions Unspecified laterality |
RIGHT UNILATERAL MASTECTOMY PROCEDURE Clinical Focus Procedure codes for right unilateral mastectomy Inclusions Exclusions Unspecified laterality |
CHEST RADIOTHERAPY Clinical Focus History of radiation to chest Inclusions Exclusions |
ATYPICAL HYPERPLASIA Clinical Focus Diagnosis codes for past atypical hyperplasia on tissue biopsy Inclusions ADH and ALH Exclusions |
ATYPICAL DUCTAL HYPERPLASIA Clinical Focus Diagnosis codes for past atypical ductal hyperplasia on tissue biopsy Inclusions Exclusions |
ATYPICAL LOBULAR HYPERPLASIA Clinical Focus Diagnosis codes for past atypical lobular hyperplasia on tissue biopsy Inclusions Exclusions |
LOBULAR CARCINOMA IN SITU Clinical Focus Diagnosis codes for past LCIS on tissue biopsy Inclusions Exclusions |
HOSPICE INTERVENTION Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
HOSPICE ENCOUNTER Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
PALLIATIVE INTERVENTION Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
PALLIATIVE ENCOUNTER Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
CODES TO IDENTIFY FRAILTY Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
DEMENTIA EXCLUSION MEDICATIONS Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
CODES TO IDENTIFY ADVANCED ILLNESS Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions |
SCREENING MAMMOGRAPHY Clinical Focus Mammogram intended for routine screening purposes Inclusions Film, digital or digital breast tomosynthesis (3D) mammography Exclusions Diagnostic mammography |
DIAGNOSTIC MAMMOGRAPHY Clinical Focus Mammogram intended for diagnostic purposes Inclusions Film, digital or digital breast tomosynthesis (3D) mammography Exclusions Screening mammography |
SCREENING MRI Clinical Focus Breast MRI intended for routine screening purposes Inclusions Exclusions Diagnostic breast MRI |
SCREENING ULTRASOUND Clinical Focus Breast ultrasound intended for routine screening purposes Inclusions Exclusions Diagnostic breast ultrasound |
DIAGNOSTIC ULTRASOUND Clinical Focus Breast ultrasound intended for diagnostic purposes Inclusions Exclusions Screening breast ultrasound |
BREAST SURGERY Clinical Focus Specialty codes for breast surgery Inclusions Exclusions |
MEDICAL ONCOLOGY Clinical Focus Specialty codes for medical oncology Inclusions Exclusions |
BREAST-RELATED SIGNS OR SYMPTOMS Clinical Focus Breast signs or symptoms which could be indicative of breast cancer. Inclusions Palpable signs, such as a breast mass, asymmetric thickening/nodularity, asymmetric breast enlargement, or change in shape/contour. Skin changes (e.g. peau d'orange, erythema, nipple excoriation, scaling, eczema, skin ulcers) Breast pain Nipple inversion, retraction, or discharge Axillary mass Exclusions |
BRCA-1 MUTATION Clinical Focus Lab codes for BRCA-1 mutation diagnostic testing. Inclusions Pathology reports Exclusions |
BRCA-2 MUTATION Clinical Focus Lab codes for BRCA-2 mutation diagnostic testing. Inclusions Pathology reports Exclusions |
BRCA-1 MUTATION CONDITION Clinical Focus Condition codes for BRCA-1 mutation carrier. Inclusions Exclusions |
BRCA-2 MUTATION CONDITION Clinical Focus Condition codes for BRCA-2 mutation carrier. Inclusions Exclusions |
GENETIC MARKER OR SYNDROME Clinical Focus Condition codes for genetic marker or syndrome associated with a high risk of breast cancer (e.g., BRCA1 or BRCA2 genetic variation). Inclusions Exclusions |
GENETIC SUSCEPTIBILITY FOR BREAST CANCER Clinical Focus Condition codes for genetic marker or syndrome associated with a high risk of breast cancer (eg, BRCA1 or BRCA2 genetic variation). Inclusions Exclusions |
LI-FRAUMENI SYNDROME Clinical Focus Condition codes for Li-Fraumeni syndrome (TP53 gene) Inclusions Exclusions |
COWDEN SYNDROME Clinical Focus Condition codes for Cowden syndrome Inclusions Exclusions |
BANNAYAN-RILEY-RUVALCABA SYNDROME Clinical Focus Condition codes for Bannayan-Riley-Ruvalcaba syndrome (PTEN gene) Inclusions Exclusions |
OVARIAN CANCER Clinical Focus Condition codes for ovarian cancer. Inclusions Exclusions |
TUBAL CANCER Clinical Focus Condition codes for tubal cancer. Inclusions Exclusions |
PERITONEAL CANCER Clinical Focus Condition codes for peritoneal cancer. Inclusions Exclusions |
BREAST BIOPSY PROCEDURE Clinical Focus Procedure codes for breast tissue biopsy Inclusions Excisional, core, and aspiration (FNA) Exclusions |
BREAST BIOPSY Clinical Focus Report type codes for breast tissue biopsy Inclusions Excisional, core, and aspiration (FNA) Exclusions |
INDETERMINATE HISTOLOGY Clinical Focus Diagnosis codes for breast tissue biopsy indeterminate results. Inclusions Exclusions |