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

PlanDefinition: High Risk Exclusions (Experimental)

Official URL: http://cancerscreeningcds.github.io/bcsm-cds/PlanDefinition/flow-HighRiskExclusions Version: 1.0.0
Draft as of 2024-10-22 Computable Name: flow-HighRiskExclusions

Copyright/Legal: (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.

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.

See here for logic path L2 representation.

Id: flow-HighRiskExclusions
Url: High Risk Exclusions
Version: 1.0.0
Title: High Risk Exclusions
Status: draft
Experimental: true
Type:

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

Date: 2024-10-22
Publisher: MITRE
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.
Knowledge Capability: executable
Knowledge Representation Level: structured
Copyright:

(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.
Approval Date: 2024-10-22
Libraries:
Library/HighRiskExclusions|1.0.0
Actions:
Annual screening mammogram starting age 30: 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.
If: Applicability: (ExistsACSGeneticRiskMammo)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSGeneticRiskMammoCode)
%action.timingTiming: (ACSGeneticRiskMammoTiming)
%action.extension: (ACSGeneticRiskMammoFlag)
code.coding[0]: (ACSGeneticRiskMammoCode)
reasonCode[0].coding[0]: (ACSGeneticRiskMammoReason)
occurrenceDateTime: (ACSGeneticRiskMammoTimingEvent)
Annual screening MRI starting age 30: 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.
If: Applicability: (ExistsACSGeneticRiskMri)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSGeneticRiskMriCode)
%action.timingTiming: (ACSGeneticRiskMriTiming)
%action.extension: (ACSGeneticRiskMriFlag)
code.coding[0]: (ACSGeneticRiskMriCode)
reasonCode[0].coding[0]: (ACSGeneticRiskMriReason)
occurrenceDateTime: (ACSGeneticRiskMriTimingEvent)
Refer to specialist recommendations: 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.
If: Applicability: (ExistsSpecialtyReferralGeneticRisk)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (SpecialtyReferralGeneticRiskCode)
code.coding[0]: (SpecialtyReferralGeneticRiskCode)
reasonCode[0].coding[0]: (SpecialtyReferralGeneticRiskReason)
Annual screening mammogram: 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.
If: Applicability: (ExistsACSMammoAfterRT)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMammoAfterRTCode)
%action.timingTiming: (ACSMammoAfterRTTiming)
%action.extension: (ACSMammoAfterRTFlag)
code.coding[0]: (ACSMammoAfterRTCode)
reasonCode[0].coding[0]: (ACSMammoAfterRTReason)
occurrenceDateTime: (ACSMammoAfterRTTimingEvent)
Annual screening MRI: 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.
If: Applicability: (ExistsACSMriAfterRT)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMriAfterRTCode)
%action.timingTiming: (ACSMriAfterRTTiming)
%action.extension: (ACSMriAfterRTFlag)
code.coding[0]: (ACSMriAfterRTCode)
reasonCode[0].coding[0]: (ACSMriAfterRTReason)
occurrenceDateTime: (ACSMriAfterRTTimingEvent)
Annual screening mammogram: Annual screening mammogram after 5 years from breast cancer onset is recomended.
If: Applicability: (ExistsACSMammoAfterBrca)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMammoAfterBrcaCode)
%action.timingTiming: (ACSMammoAfterBrcaTiming)
%action.extension: (ACSMammoAfterBrcaFlag)
code.coding[0]: (ACSMammoAfterBrcaCode)
reasonCode[0].coding[0]: (ACSMammoAfterBrcaReason)
occurrenceDateTime: (ACSMammoAfterBrcaTimingEvent)
Refer to Oncologic care plan: 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.
If: Applicability: (ExistsSpecialtyReferralBreastCaWithin5y)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (SpecialtyReferralBreastCaWithin5yCode)
code.coding[0]: (SpecialtyReferralBreastCaWithin5yCode)
reasonCode[0].coding[0]: (SpecialtyReferralBreastCaWithin5yReason)
Annual screening mammogram starting age 30: 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.
If: Applicability: (ExistsACSMammoAtypicalBiopsy)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMammoAtypicalBiopsyCode)
%action.timingTiming: (ACSMammoAtypicalBiopsyTiming)
%action.extension: (ACSMammoAtypicalBiopsyFlag)
code.coding[0]: (ACSMammoAtypicalBiopsyCode)
reasonCode[0].coding[0]: (ACSMammoAtypicalBiopsyReason)
occurrenceDateTime: (ACSMammoAtypicalBiopsyTimingEvent)
Perform lifetime risk assessment: Consider performing assessment of lifetime risk. If estimated lifetime risk is >20%, patient may be eligible for supplemental screening with annual screening MRI.
If: Applicability: (ExistsACSAtypicalBiopsy)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSAtypicalBiopsyCode)
code.coding[0]: (ACSAtypicalBiopsyCode)
reasonCode[0].coding[0]: (ACSAtypicalBiopsyReason)
Annual screening MRI starting age 30: An annual screening MRI starting at age 30 is recommended in patients with past atypical biopsy and lifetime risk > 20-25%.
If: Applicability: (ExistsACSMriAtypicalBiopsyHighRisk)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMriAtypicalBiopsyHighRiskCode)
%action.timingTiming: (ACSMriAtypicalBiopsyHighRiskTiming)
%action.extension: (ACSMriAtypicalBiopsyHighRiskFlag)
code.coding[0]: (ACSMriAtypicalBiopsyHighRiskCode)
reasonCode[0].coding[0]: (ACSMriAtypicalBiopsyHighRiskReason)
occurrenceDateTime: (ACSMriAtypicalBiopsyHighRiskTimingEvent)

Notes: