Screening of breast cancer

(JAMA 2015;314:1599; Annals 2019;170:547)

• Mammography: ~20–30% ↓ in breast cancer mortality,
  • smaller abs. benefit in women <50 y (JAMA 2018;319:1814); digital breast tomosynthesis (3-D) ↑ specificity (JAMA Oncol 2019;5:635); suspicious findings: clustered microcalcifications, spiculated, enlarging
• ACS: annual mammo starting at 45 (consider biennial after 54), cont. if life expect ≥10 y
• USPSTF: screen biennially ages 50–75 (some may want to begin at 40)
• ↑ risk: screen earlier w/ exam and mammo (age 25 in BRCA1/2 carrier, 5–10 y before earliest FHx case, 8–10 y after thoracic RT, upon dx of ↑ risk benign disease)
• MRI: superior to mammo in high-risk and young Pts; consider annually if >20% lifetime risk (eg, ⊕ FHx, BRCA1/2, prior chest RT) (Lancet 2011;378:1804)
• Germline genetic testing: if metastatic, TNBC, ♂, age ≤45y, or by FHx (NCCN v1.2022)

癌症篩檢介紹

NCCN 說 40以上，年年做馬某