CLINICAL PRACTICE GUIDELINES

BREAST MASS SCREENING

I. INTRODUCTION

Breast cancer is diagnosed in approximately 180,000 women per year in the US. It is the most common cancer in women and the second leading cause of cancer death.

II. SUBJECTIVE

A. Mass

duration
change in menstrual cycle
change over time
pain

B. Prior history of breast problems

C. Gravidity/Parity

age at first birth

D. Menopausal status

If s/p hysterectomy, was oophrectomy performed?

E. Age at menarche

F. Exogenous hormones

oral contraceptives
postmenopausal hormone replacement duration

G. Family History

age at diagnosis of breast cancer
bilateral?
GYN malignancy

H. Personal history of other malignancy

III. OBJECTIVE

A. Mass

location
size
tenderness
well-circumscribed?
fixed to skin or chest wall
smooth

B. Nodes

axillary
supraclavicular
infraclavicular

C. Nipple

discharge bloody?
excoriation (Paget's)

D. X-ray

mammogram

screening

35 - 40 yo: baseline

40 - 50 yo: every other year controversial

>50yo: yearly

diagnostic

not useful in women < 25 yo except in special circumstances
A NEGATIVE MAMMOGRAM DOES NOT EXCLUDE CARCINOMA IN A WOMAN WITH A PALPABLE BREAST MASS. 10% of malignancies will not be visualized on a mammogram.
ultrasound

primarily used to distinguish solid from cystic masses

not useful for screening

IV/V. ASSESSMENT/PLAN

A. Abnormal screening mammogram

stereotactic core needle biopsy

can be performed by surgeon or radiologist

not recommended for highly suspicious lesions

Pt. should be evaluated by a surgeon as well as by a radiologist

open surgical biopsy

indicated for lesions highly suspicious for malignancy and for lesions not amenable tostereotactic core biopsy.

ultrasound guided core biopsy

useful in nonpalpable solid lesions visible on ultrasound with low suspicion of malignancy

B. Palpable mass

stereotactic core and ultrasound guided core biopsy not indicated for a palpable mass

pt should be referred for surgical evaluation and
treatment

VI. PATIENT EDUCATION

A. Benign breast mass

Most patients with benign breast biopsy are at minimal to no increased risk of breast carcinoma, excluding other risk factors. Exceptions include atypical
hyperplasia (relative risk to approximately 4).

B. Carcinoma

There are options of therapy depending on the size of the tumor, nodal status, and other factors.


VII. FOLLOW-UP

A. All women should have yearly physical examination, including breast examination, by a health care provider.
B. Screening mammograms should be performed as above.
C. Women at high risk for developing breast cancer (previous cancer, strong family history, etc.) and women with difficult to follow breast exams should be seen more often for exam by a health care provider and may need mammography more often than recommended by the screening guidelines above.
Surgery
1996

For more information about this protocol, please email PROTOCOLS@UTMEM.EDU