Breast Cancer Screening and Management (BCSM) Clinical Decision Support (CDS) Implementation Guide
1.0.0 - ci-build
Breast Cancer Screening and Management (BCSM) Clinical Decision Support (CDS) Implementation Guide - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2024-10-22 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="PrimaryScreeningDecision"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computableplandefinition"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">PrimaryScreeningDecision</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-PrimaryScreeningDecision.html">Primary Screening Decision</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">1.0.0</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Primary Screening Decision</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Experimental: </b></th>
<td style="padding-left: 4px;">true</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://terminology.hl7.org/6.2.0/CodeSystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
</p>
<p style="margin-bottom: 5px;">
<b>code: </b> <span>eca-rule</span>
</p>
<p style="margin-bottom: 5px;">
<b>display: </b> <span>ECA Rule</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2024-10-22</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">MITRE</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Primary Screening Decision pathway.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Knowledge Capability: </b></th>
<td style="padding-left: 4px;">
executable
</td>
</tr>
<tr>
<th scope="row"><b>Knowledge Representation Level: </b></th>
<td style="padding-left: 4px;">
structured
</td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>(C) 2024 The MITRE Corporation. All Rights Reserved. Approved for Public Release: 24-2711. Distribution Unlimited. Unless otherwise noted, this work is available under an Apache 2.0 license. It was produced by the MITRE Corporation for the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in accordance with the Statement of Work, contract number 75FCMC18D0047, task order number 75D30123F17931.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Approval Date: </b></th>
<td style="padding-left: 4px;">2024-10-22</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><code>Library/PrimaryScreeningDecision|1.0.0</code></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Not eligible for screening:</b> This patient is not eligible for screening.
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'
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsNotEligibleNotAssignedFemaleAtBirth)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
reasonCode[0].coding[0]: <i>(ScreeningEligibleReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Refer to Oncologic care plan:</b> This patient is not eligible for routine screening and should be referred to a specialist for management.
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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsNotEligibleCurrentBreastCancer)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
reasonCode[0].coding[0]: <i>(ScreeningEligibleReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Not eligible for screening:</b> This patient is not eligible for screening.
New breast symptoms or exam findings, or chronic symptoms or findings which have progressively worsened, should undergo diagnostic testing rather than routine screening.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsNotEligibleBreastSymptomsOrFindings)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
reasonCode[0].coding[0]: <i>(ScreeningEligibleReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Not eligible for screening:</b> This patient is not eligible for screening.
This patient has had bilateral mastectomy and does not meet the eligibility requirements for routine breast cancer screening.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsNotEligibleBilateralMastectomy)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
reasonCode[0].coding[0]: <i>(ScreeningEligibleReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Shared decision making to continue screening based on age:</b> Decision to continue screening mammography in average risk women age 75 years or older should be based on shared decision-making.
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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsSDMContinueScreeningAge)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateSDMContinueScreening|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(SDMContinueScreeningAgeCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(SDMContinueScreeningAgeReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Shared decision making to continue screening based on life expectancy:</b> Decision to continue screening mammography in cases of limited life expectancy should be based on shared decision-making.
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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsSDMContinueScreeningLifeExp)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateSDMContinueScreening|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(SDMContinueScreeningLifeExpCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(SDMContinueScreeningLifeExpReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Shared decision making to delay screening based on lactation status:</b> 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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsSDMDelayScreeningLactating)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateSDMDelayScreening|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(SDMDelayScreeningLactatingCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(SDMDelayScreeningLactatingReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram starting age 30:</b> An annual screening mammogram starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on known genetic markers or syndromes should get a mammogram every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSGeneticRiskMammo)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSGeneticRiskMammoCode)</i>
<br/>
%action.timingTiming: <i>(ACSGeneticRiskMammoTiming)</i>
<br/>
%action.extension: <i>(ACSGeneticRiskMammoFlag)</i>
<br/>
code.coding[0]: <i>(ACSGeneticRiskMammoCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSGeneticRiskMammoReason)</i>
<br/>
occurrenceDateTime: <i>(ACSGeneticRiskMammoTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening MRI starting age 30:</b> An annual screening MRI starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on known genetic markers or syndromes should get a breast MRI every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSGeneticRiskMri)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSGeneticRiskMriCode)</i>
<br/>
%action.timingTiming: <i>(ACSGeneticRiskMriTiming)</i>
<br/>
%action.extension: <i>(ACSGeneticRiskMriFlag)</i>
<br/>
code.coding[0]: <i>(ACSGeneticRiskMriCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSGeneticRiskMriReason)</i>
<br/>
occurrenceDateTime: <i>(ACSGeneticRiskMriTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Refer to specialist recommendations:</b> 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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsSpecialtyReferralGeneticRisk)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(SpecialtyReferralGeneticRiskCode)</i>
<br/>
code.coding[0]: <i>(SpecialtyReferralGeneticRiskCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(SpecialtyReferralGeneticRiskReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram:</b> An annual screening mammogram starting 8 years after radiotherapy and no earlier than age 25 is recommended.
Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoAfterRT)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoAfterRTCode)</i>
<br/>
%action.timingTiming: <i>(ACSMammoAfterRTTiming)</i>
<br/>
%action.extension: <i>(ACSMammoAfterRTFlag)</i>
<br/>
code.coding[0]: <i>(ACSMammoAfterRTCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoAfterRTReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoAfterRTTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening MRI:</b> An annual screening MRI starting 8 years after radiotherapy and no earlier than age 25 is recommended.
Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMriAfterRT)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMriAfterRTCode)</i>
<br/>
%action.timingTiming: <i>(ACSMriAfterRTTiming)</i>
<br/>
%action.extension: <i>(ACSMriAfterRTFlag)</i>
<br/>
code.coding[0]: <i>(ACSMriAfterRTCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMriAfterRTReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMriAfterRTTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram:</b> Annual screening mammogram after 5 years from breast cancer onset is recomended.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoAfterBrca)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoAfterBrcaCode)</i>
<br/>
%action.timingTiming: <i>(ACSMammoAfterBrcaTiming)</i>
<br/>
%action.extension: <i>(ACSMammoAfterBrcaFlag)</i>
<br/>
code.coding[0]: <i>(ACSMammoAfterBrcaCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoAfterBrcaReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoAfterBrcaTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Refer to Oncologic care plan:</b> 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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsSpecialtyReferralBreastCaWithin5y)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(SpecialtyReferralBreastCaWithin5yCode)</i>
<br/>
code.coding[0]: <i>(SpecialtyReferralBreastCaWithin5yCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(SpecialtyReferralBreastCaWithin5yReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram starting age 30:</b> An annual screening mammogram starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on past atypical biopsy should get a mammogram every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoAtypicalBiopsy)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoAtypicalBiopsyCode)</i>
<br/>
%action.timingTiming: <i>(ACSMammoAtypicalBiopsyTiming)</i>
<br/>
%action.extension: <i>(ACSMammoAtypicalBiopsyFlag)</i>
<br/>
code.coding[0]: <i>(ACSMammoAtypicalBiopsyCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoAtypicalBiopsyReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoAtypicalBiopsyTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Perform lifetime risk assessment:</b> Consider performing assessment of lifetime risk.
If estimated lifetime risk is >20%, patient may be eligible for supplemental screening with annual screening MRI.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSAtypicalBiopsy)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSAtypicalBiopsyCode)</i>
<br/>
code.coding[0]: <i>(ACSAtypicalBiopsyCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSAtypicalBiopsyReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening MRI starting age 30:</b> An annual screening MRI starting at age 30 is recommended in patients with past atypical biopsy and lifetime risk > 20-25%.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMriAtypicalBiopsyHighRisk)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsHighRiskExclusionsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMriAtypicalBiopsyHighRiskCode)</i>
<br/>
%action.timingTiming: <i>(ACSMriAtypicalBiopsyHighRiskTiming)</i>
<br/>
%action.extension: <i>(ACSMriAtypicalBiopsyHighRiskFlag)</i>
<br/>
code.coding[0]: <i>(ACSMriAtypicalBiopsyHighRiskCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMriAtypicalBiopsyHighRiskReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMriAtypicalBiopsyHighRiskTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram starting age 30:</b> An annual screening mammogram starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on certain risk factors should get a mammogram every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoHighRisk)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoHighRiskCode)</i>
<br/>
%action.timingTiming: <i>(ACSMammoHighRiskTiming)</i>
<br/>
%action.extension: <i>(ACSMammoHighRiskFlag)</i>
<br/>
code.coding[0]: <i>(ACSMammoHighRiskCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoHighRiskReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoHighRiskTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening MRI starting age 30:</b> An annual screening MRI starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on certain risk factors should get a breast MRI every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMriHighRisk)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMriHighRiskCode)</i>
<br/>
%action.timingTiming: <i>(ACSMriHighRiskTiming)</i>
<br/>
%action.extension: <i>(ACSMriHighRiskFlag)</i>
<br/>
code.coding[0]: <i>(ACSMriHighRiskCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMriHighRiskReason)</i>
<br/>
occurrenceDateTime: <i>(ACSMriHighRiskTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammo starting age 30:</b> An annual screening mammogram starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on certain risk factors should get a mammogram every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSFirstDegGeneticMammo)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSFirstDegGeneticMammoCode)</i>
<br/>
%action.timingTiming: <i>(ACSFirstDegGeneticMammoTiming)</i>
<br/>
%action.extension: <i>(ACSFirstDegGeneticMammoFlag)</i>
<br/>
code.coding[0]: <i>(ACSFirstDegGeneticMammoCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSFirstDegGeneticMammoReason)</i>
<br/>
occurrenceDateTime: <i>(ACSFirstDegGeneticMammoTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening MRI starting age 30:</b> An annual screening MRI starting at age 30 is recommended.
Women who are at higher than average risk for breast cancer based on certain risk factors should get a breast MRI every year, typically starting at age 30.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSFirstDegGeneticMri)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSFirstDegGeneticMriCode)</i>
<br/>
%action.timingTiming: <i>(ACSFirstDegGeneticMriTiming)</i>
<br/>
%action.extension: <i>(ACSFirstDegGeneticMriFlag)</i>
<br/>
code.coding[0]: <i>(ACSFirstDegGeneticMriCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSFirstDegGeneticMriReason)</i>
<br/>
occurrenceDateTime: <i>(ACSFirstDegGeneticMriTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Perform lifetime risk assessment:</b> Consider performing assessment of lifetime risk, as defined by models largely dependent on family history.
If estimated lifetime risk is >20%, based on informal assessment or assessment using validated risk model, then patient is eligible for annual screening mammogram starting at age 30 and supplemental screening with annual screening MRI. Otherwise, patient can be offered annual screening mammogram starting at age 40.
Validated tools include BRCAPRO, Claus, BOADICEA [Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm], and Tyrer-Cuzick.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsBreastImagingHeterogenouslyOrExtremelyDense)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
reasonCode[0].coding[0]: <i>(BreastImagingHeterogenouslyOrExtremelyDenseReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Perform lifetime risk assessment:</b> Consider performing assessment of lifetime risk, as defined by models largely dependent on family history.
If estimated lifetime risk is >20%, based on informal assessment or assessment using validated risk model, then patient is eligible for annual screening mammogram starting at age 30 and supplemental screening with annual screening MRI. Otherwise, patient can be offered annual screening mammogram starting at age 40.
Validated tools include BRCAPRO, Claus, BOADICEA [Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm], and Tyrer-Cuzick.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsCompellingFamilyHistory)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(CompellingFamilyHistoryCode)</i>
<br/>
code.coding[0]: <i>(CompellingFamilyHistoryCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(CompellingFamilyHistoryReason)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Biennial screening mammo starting age 40:</b> Biennial screening mammogram starting at age 40
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsUSPSTFRecommendation)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsSpecialPopulationsRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(USPSTFRecommendationCode)</i>
<br/>
%action.timingTiming: <i>(USPSTFRecommendationTiming)</i>
<br/>
%action.extension: <i>(USPSTFRecommendationFlag)</i>
<br/>
code.coding[0]: <i>(USPSTFRecommendationCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(USPSTFRecommendationReason)</i>
<br/>
occurrenceDateTime: <i>(USPSTFRecommendationTimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram starting age 40:</b> Women between 40 and 44 have the option to start screening with a mammogram every year.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoAvgRiskAgeUnder45)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsAverageRiskRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoAvgRiskAgeUnder45Code)</i>
<br/>
%action.timingTiming: <i>(ACSMammoAvgRiskAgeUnder45Timing)</i>
<br/>
%action.extension: <i>(ACSMammoAvgRiskAgeUnder45Flag)</i>
<br/>
code.coding[0]: <i>(ACSMammoAvgRiskAgeUnder45Code)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoAvgRiskAgeUnder45Reason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoAvgRiskAgeUnder45TimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Annual screening mammogram starting age 40:</b> Annual screening mammogram is recommended for women 45 to 54.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoAvgRiskAge45to54)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsAverageRiskRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoAvgRiskAge45to54Code)</i>
<br/>
%action.timingTiming: <i>(ACSMammoAvgRiskAge45to54Timing)</i>
<br/>
%action.extension: <i>(ACSMammoAvgRiskAge45to54Flag)</i>
<br/>
code.coding[0]: <i>(ACSMammoAvgRiskAge45to54Code)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoAvgRiskAge45to54Reason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoAvgRiskAge45to54TimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Biennial screening mammogram after age 54:</b> Biennial screening mammogram is recommended after age 54.
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.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsACSMammoAvgRiskAgeOver54)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsAverageRiskRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(ACSMammoAvgRiskAgeOver54Code)</i>
<br/>
%action.timingTiming: <i>(ACSMammoAvgRiskAgeOver54Timing)</i>
<br/>
%action.extension: <i>(ACSMammoAvgRiskAgeOver54Flag)</i>
<br/>
code.coding[0]: <i>(ACSMammoAvgRiskAgeOver54Code)</i>
<br/>
reasonCode[0].coding[0]: <i>(ACSMammoAvgRiskAgeOver54Reason)</i>
<br/>
occurrenceDateTime: <i>(ACSMammoAvgRiskAgeOver54TimingEvent)</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Biennial screening mammogram starting age 40:</b> Biennial screening mammogram starting at age 40
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsUSPSTFAvgRisk)</i>
<br/>
<i>Applicability:</i>
<i>(ExistsAverageRiskRecommendations)</i>
<br/>
<i>Applicability:</i>
<i>(CheckIsIncludedAndNotExcluded)</i>
<br/>
<i>Applicability:</i>
<i>(IsScreeningEligible)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
%action.code[0].coding[0]: <i>(USPSTFAvgRiskCode)</i>
<br/>
%action.timingTiming: <i>(USPSTFAvgRiskTiming)</i>
<br/>
%action.extension: <i>(USPSTFAvgRiskFlag)</i>
<br/>
code.coding[0]: <i>(USPSTFAvgRiskCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(USPSTFAvgRiskReason)</i>
<br/>
occurrenceDateTime: <i>(USPSTFAvgRiskTimingEvent)</i>
<br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="executable"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeRepresentationLevel">
<valueCode value="structured"/>
</extension>
<url
value="http://cancerscreeningcds.github.io/bcsm-cds/PlanDefinition/PrimaryScreeningDecision"/>
<version value="1.0.0"/>
<name value="PrimaryScreeningDecision"/>
<title value="Primary Screening Decision"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
<display value="ECA Rule"/>
</coding>
</type>
<status value="draft"/>
<experimental value="true"/>
<date value="2024-10-22"/>
<publisher value="MITRE"/>
<contact>
<name value="MITRE"/>
<telecom>
<system value="url"/>
<value value="https://www.mitre.org/"/>
</telecom>
</contact>
<description value="Primary Screening Decision pathway."/>
<copyright
value="(C) 2024 The MITRE Corporation. All Rights Reserved. Approved for Public Release: 24-2711. Distribution Unlimited. Unless otherwise noted, this work is available under an Apache 2.0 license. It was produced by the MITRE Corporation for the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in accordance with the Statement of Work, contract number 75FCMC18D0047, task order number 75D30123F17931."/>
<approvalDate value="2024-10-22"/>
<lastReviewDate value="2024-10-22"/>
<author>
<name
value="The Health FFRDC, operated by The MITRE Corporation, in support of the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention."/>
</author>
<editor>
<name
value="Division of Cancer Prevention and Control, Centers for Disease Control and Prevention"/>
</editor>
<reviewer>
<name
value="Division of Cancer Prevention and Control, Centers for Disease Control and Prevention"/>
</reviewer>
<endorser>
<name
value="Division of Cancer Prevention and Control, Centers for Disease Control and Prevention"/>
</endorser>
<library value="Library/PrimaryScreeningDecision|1.0.0"/>
<action id="NotEligibleCurrentBreastCancer">
<title value="Not eligible for screening"/>
<description
value="This patient is not eligible for screening.
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'"/>
<code>
<coding>
<system
value="http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/plan-definition-action-code-system"/>
<code value="noteligible"/>
<display value="Not eligible for screening"/>
</coding>
</code>
<documentation>
<type value="citation"/>
<label value="USPSTF"/>
<display
value="Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement"/>
<citation
value="US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024."/>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
<document>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
</document>
</documentation>
<documentation>
<type value="derived-from"/>
<label value="Screening Eligible"/>
<display
value="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."/>
</documentation>
<documentation>
<type value="documentation"/>
<label value="ACR"/>
<display
value="ACR Appropriateness Criteria® Transgender Breast Cancer Screening"/>
<citation
value="Brown, Ann, et al. "ACR appropriateness criteria® transgender breast cancer screening." Journal of the American College of Radiology 18.11 (2021): S502-S515."/>
<url
value="https://www.jacr.org/article/S1546-1440(21)00730-4/fulltext"/>
<document>
<url
value="https://www.jacr.org/article/S1546-1440(21)00730-4/fulltext"/>
</document>
</documentation>
<documentation>
<type value="documentation"/>
<label value="UCSF"/>
<display
value="UCSF Transgender Care & Treatment Guidelines: Screening for breast cancer in transgender women"/>
<url value="https://transcare.ucsf.edu/guidelines/breast-cancer-women"/>
<document>
<url
value="https://transcare.ucsf.edu/guidelines/breast-cancer-women"/>
</document>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="CheckIsIncludedAndNotExcluded"/>
</expression>
</condition>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ExistsNotEligibleNotAssignedFemaleAtBirth"/>
</expression>
</condition>
<definitionCanonical
value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0"/>
<dynamicValue>
<path value="reasonCode[0].coding[0]"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ScreeningEligibleReason"/>
</expression>
</dynamicValue>
</action>
<action id="NotEligibleCurrentBreastCancer">
<title value="Refer to Oncologic care plan"/>
<description
value="This patient is not eligible for routine screening and should be referred to a specialist for management.
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."/>
<code>
<coding>
<system
value="http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/plan-definition-action-code-system"/>
<code value="noteligible"/>
<display value="Not eligible for screening"/>
</coding>
</code>
<documentation>
<type value="citation"/>
<label value="USPSTF"/>
<display
value="Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement"/>
<citation
value="US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024."/>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
<document>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
</document>
</documentation>
<documentation>
<type value="derived-from"/>
<label value="Screening Eligible"/>
<display
value="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."/>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="CheckIsIncludedAndNotExcluded"/>
</expression>
</condition>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ExistsNotEligibleCurrentBreastCancer"/>
</expression>
</condition>
<definitionCanonical
value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0"/>
<dynamicValue>
<path value="reasonCode[0].coding[0]"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ScreeningEligibleReason"/>
</expression>
</dynamicValue>
</action>
<action id="NotEligibleBreastSymptomsOrFindings">
<title value="Not eligible for screening"/>
<description
value="This patient is not eligible for screening.
New breast symptoms or exam findings, or chronic symptoms or findings which have progressively worsened, should undergo diagnostic testing rather than routine screening."/>
<code>
<coding>
<system
value="http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/plan-definition-action-code-system"/>
<code value="noteligible"/>
<display value="Not eligible for screening"/>
</coding>
</code>
<documentation>
<type value="citation"/>
<label value="USPSTF"/>
<display
value="Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement"/>
<citation
value="US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024."/>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
<document>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
</document>
</documentation>
<documentation>
<type value="derived-from"/>
<label value="Screening Eligible"/>
<display
value="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."/>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="CheckIsIncludedAndNotExcluded"/>
</expression>
</condition>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ExistsNotEligibleBreastSymptomsOrFindings"/>
</expression>
</condition>
<definitionCanonical
value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0"/>
<dynamicValue>
<path value="reasonCode[0].coding[0]"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ScreeningEligibleReason"/>
</expression>
</dynamicValue>
</action>
<action id="NotEligibleBilateralMastectomy">
<title value="Not eligible for screening"/>
<description
value="This patient is not eligible for screening.
This patient has had bilateral mastectomy and does not meet the eligibility requirements for routine breast cancer screening."/>
<code>
<coding>
<system
value="http://cancerscreeningcds.github.io/bcsm-cds/CodeSystem/plan-definition-action-code-system"/>
<code value="noteligible"/>
<display value="Not eligible for screening"/>
</coding>
</code>
<documentation>
<type value="citation"/>
<label value="USPSTF"/>
<display
value="Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement"/>
<citation
value="US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024."/>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
<document>
<url
value="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening"/>
</document>
</documentation>
<documentation>
<type value="derived-from"/>
<label value="Screening Eligible"/>
<display
value="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."/>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="CheckIsIncludedAndNotExcluded"/>
</expression>
</condition>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ExistsNotEligibleBilateralMastectomy"/>
</expression>
</condition>
<definitionCanonical
value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/CommunicateNotEligible|1.0.0"/>
<dynamicValue>
<path value="reasonCode[0].coding[0]"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="ScreeningEligibleReason"/>
</expression>
</dynamicValue>
</action>
<action id="SDMContinueScreeningAge">
<title value="Shared decision making to continue screening based on age"/>
<description
value="Decision to continue screening mammography in average risk women age 75 years or older should be based on shared decision-making.
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