Screening

• Self breast exam (SBE): no proven mortality benefit (JNCI 2002:94 1445)

• Clinical breast exam (CBE): benefit independent of mammography not established

• Mammography 20-30% A in breast cancer mortality (smaller absolute benefit in women 50) (toncrt 2001.358 1340 & 2002.359:909: Awwfc 2002.137:347; Lmcet 2006:368-2053) suspicious lesions: clustered microcalcifications, spiculated or enlarging masses

• Most U.S. groups recommend annual mammography • CBE beginning at age 40

Women at t risk: screen earlier (age 25 in BRCA1 2 carrier, 5-10 y before earliest © FHx index case. 8-10 y after thoracic irradiation, upon dx of t risk benign conditions) MRI superior to mammo in high-risk PtS [NEjM 2004.351:427;lancet 2005:365 1769) Women with strong FHx should be evaluated for possible genetic testing

• MRI: consider if -20-25% lifetime risk (eg. • i FHx. BRCA 1 or 2. prior chest XRT)

(jama 2006:295:2375: ca 2007.57:75)

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