Clinical Practice: This Breast Cancer Awareness Month, Discuss Screening with Your Patients

A well-woman visit to an ob-gyn offers an excellent opportunity for health care providers and patients to discuss the importance of maintaining a healthy lifestyle in order to minimize health risks. The visit should include screening, evaluation and counseling, and immunizations based on age and risk factors.

For Breast Cancer Awareness Month, encourage your patients to come in for a well-woman visit. A well-woman visit is a good time to talk about breast health; for women ages 40 and older, this is an opportunity to discuss breast cancer screening. Shared decision making between a patient and her ob-gyn is particularly important for decisions regarding breast cancer screening because many choices involve personal preferences related to potential benefits and adverse consequences.

Refresh your knowledge of ACOG’s breast cancer screening recommendations to better facilitate these conversations with your patients:

  • Women at average risk of breast cancer should be offered screening mammography starting at and no earlier than age 40. If they have not initiated screening in their 40s, they should begin screening mammography by no later than age 50 years. The decision about the age to begin mammography screening should be made through a shared decision-making process. This discussion should include information about the potential benefits and harms of screening.
  • Women at average risk of breast cancer should have screening mammography every one or two years based on an informed, shared decision-making process that includes a discussion of the benefits and harms of annual and biennial screening and incorporates patient values and preferences. Biennial screening mammography, particularly after age 55 years, is a reasonable option to reduce the frequency of harms, if patient counseling includes a discussion that with decreased screening comes some reduction in benefits.
  • Women at average risk of breast cancer should continue screening mammography until at least age 75 years.
  • Screening clinical breast examination may be offered to asymptomatic, average-risk women in the context of an informed, shared decision-making approach that recognizes the uncertainty of additional benefits and the possibility of adverse consequences of clinical breast examination beyond screening mammography. If performed for screening, intervals of every one to three years for women aged 25–39 years and annually for women aged 40 years and older are reasonable. The clinical breast examination continues to be a recommended part of evaluation of high-risk women and women with symptoms.
  • Patients should be counseled about breast self-awareness and encouraged to notify their health care provider if they experience a change. Breast self-awareness is defined as a woman’s awareness of the normal appearance and feel of her breasts.
  • Age alone should not be the basis to continue or discontinue screening. Beyond age 75 years, the decision to discontinue screening mammography should be based on a shared decision making process informed by the woman’s health status and longevity.

For more information, see ACOG’s Breast Cancer Screening and Treatment resource overview page and Practice Bulletin 179, “Breast Cancer Risk Assessment and Screening in Average-Risk Women.”

ACOG’s comprehensive recommendations and resources for well-women care are available online at www.acog.org/wellwoman

American Congress of Obstetricians and Gynecologists
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