Breast Imaging Update - FOMA District 2€¦ · Breast Imaging Update Gaelyn Scuderi, ... Answer...
Transcript of Breast Imaging Update - FOMA District 2€¦ · Breast Imaging Update Gaelyn Scuderi, ... Answer...
Breast Imaging Update
Gaelyn Scuderi, M.D.
Jacksonville VA Outpatient Clinic
Objectives
Outline existing multiple recommendations for
screening mammography.
Summarize the current controversies surrounding
screening mammography.
Introduce new imaging technologies and define
parameters for usage of alternate screening modalities.
Answer common questions regarding the breast
imaging workup.
Controversies in Screening
Mammography
Age When to start?
When to stop?
Frequency Annual
Biennial
Breast density Increased risk?
Supplemental screening? Payment?
Overdiagnosis
BENEFITS vs. HARMS
Controversies in Screening
Mammography
Multiple Guidelines
American College of Radiology (ACR)
Society of Breast Imaging (SBI)
American Cancer Society (ACS)
US Preventative Services Task Force (USPSTF)
USPSTF
ACS
ACR/SBI
Less imaging
More imaging
Controversies in Screening Mammography
Yearly screening beginning at age 40
for average risk females
American College of Radiology and
Society of Breast Imaging
Controversies in Screening Mammography
Yearly screening beginning at age 30 for females with 20% or greater lifetime risk BRCA 1 or 2 positive
family history risk calculation
premenopausal first degree relative)
or ten years earlier than the youngest family member diagnosed with breast malignancy, not before age 25
Yearly within 8 years of mantle irradiation, not before age 25
Yearly in all women with biopsy-proven breast cancer or ovarian cancer
American College of Radiology and
Society of Breast Imaging
Controversies in Screening Mammography
Continue screening indefinitely as long as:
5-7 years of remaining life expectancy
Willing to undergo additional testing including
biopsy
Would undergo at least limited treatment of breast
cancer if diagnosed
American College of Radiology and
Society of Breast Imaging
Controversies in Screening Mammography
Yearly screening from ages 45-54
for average risk females
American Cancer Society
Controversies in Screening Mammography
Access to annual screening
for women 40-44 years
American Cancer Society
Controversies in Screening Mammography
Biennial screening in women >55 years
for average risk females
OR
Access to annual screening
American Cancer Society
Controversies in Screening Mammography
Continue screening indefinitely as long as life
expectancy is 10 years or longer
American Cancer Society
Controversies in Screening Mammography
USPSTF
Controversies in Screening Mammography
American Society of Breast Surgeons
Controversies in Screening Mammography:
Benefits vs. Harms
Benefits
Mortality reduction
Extension of life expectancy
Improved quality of life aka QALY
quality-adjusted life years gained
Harms
“Overdiagnosis”
Patient anxiety related to false positive exams
False negative exams
Breast density
Controversies in Screening Mammography:
Adjunctive Screening
Breast MRI
Whole Breast Ultrasound
3D Digital Breast Tomosynthesis
Common Breast Imaging Questions
Breast MRI
Whole Breast Ultrasound
3D Digital Breast Tomosynthesis