ABFM :ABFM Health Counseling and Preventive Care Exam: Questions & Answers: Latest Updated A+ Score Guide

A 50-year-old female sees you for a routine health maintenance visit. She is asymptomatic and has no known family history of cancer. She underwent breast augmentation surgery 20 years ago. On examination she has a BMI of 22 kg/m2.According to the U.S. Preventive Services Task Force, which one of the following has the best evidence for breast cancer screening for this patient at this time? Monthly breast self-examinations Mammography only A clinical breast examination and mammography Breast MRI only Mammography, followed by breast MRI if dense breast tissue is noted on mammography (Ans- B The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography every 1-2 years beginning at age 50 for all women (B recommendation). The USPSTF recommends against teaching breast self-examination (D recommendation) and has found insufficient evidence to recommend for or against clinical breast examinations to screen asymptomatic women (I recommendation). Clinical trials have not found that mortality is improved in women screened with a clinicalbreast examination when done in concert with mammography. The patient should be provided with this information and the physician should ask about her preferences with regard to the clinical breast examination. The American Cancer Society has somewhat different recommendations for breast cancer screening as noted below: Women age 40-44 may choose to start annual screening mammography Women age 45-54 should have annual mammography Women age 55 and older should switch to mammography every 2 years, or may choose to continue annual screening Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening Which recommendations to follow are a source of controversy in clinical practice and for patient education. The USPSTF has concluded that the evidence is insufficient to assess the benefits and harms of MRI screening for breast cancer (I recommendation). The American Cancer Society recommends annual MRI screening in addition to mammography for women with a ≥20% lifetime risk for breast cancer, and recommends against MRI screening for women with a ≤15% lifetime risk (SOR C). There is insufficient evidence at this time to make a recommendation for or against yearly MRI screening for women who have a h