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  • br Breast Cancer Screening Modalities


    Breast Cancer Screening Modalities
    There are different views on the screening modalities for breast cancer. In addition, guidelines differ on when to start or stop screening, benefits and harms of screening, and the issue of false-positive and false-negative findings. Although screening can save lives, it Kainic acid can trigger unnecessary procedures including biopsies, testing recalls, mastectomies, systemic drug therapy, days off work, radiation, and debt related to health care costs.18 Medicare Accountable Care Organizations' roles are to prevent negative ef-fects from breast cancer screening such as harms, overtreatment, and overdiagnosis.19 Similarly, Accountable Care Organizations advocate for quality care by offering incentives to providers to co-ordinate breast cancer screening. While these incentives were offered, some providers were concerned about reporting of poor performance ratings and the potential risk of medical malpractice.18
    Self-breast Examination
    The National Institutes of Health does not recommend self-breast examination (SBE) for early breast cancer detection because it does not decrease mortality rates. Evidence revealed that SBE external validity was poor, and it may increase a patient’s 
    anxiety and lead to unnecessary biopsies.13 The American Academy of Family Physicians (AAFP) also does not advise practitioners to teach patients SBE. However, both organizations do recommend assessing patients’ screening values, screening preferences, and breast cancer risk factors; discussing a patient’s potential benefits of screening using an appropriate screening test; developing early detection plans; and minimizing potential screening harms. Although BSE is not recommended, ACOG guidelines recom-mended women practice breast self-awareness (eg, awareness of normal appearance and feel of the breast). This is important for NPs to be aware of, so they can counsel patients about signs and symptoms of breast cancer. Teach patients to report any redness, new onset of nipple discharge, mass, or pain.
    Clinical Breast Examination
    The consistency and external validity of clinical breast exami-nation (CBE) is poor.13 It has not been shown to decrease mortality rates, and its efficacy for early detection of breast cancer is unclear. CBE may lead to additional testing, anxiety, false reassurance, and delay in cancer diagnosis.13 It was reported that 17% to 43% of women with breast cancer have a negative CBE.13 The US Preventive Services Task Force (USPSTF) guidelines do not recommend CBE based on the lack of a standardized and structured approach used by providers in performing this examination. However, the Na-tional Comprehensive Cancer Network (NCCN) does recommend CBE if BRCA is positive; sediment should begin at age 25.
    However, Provencher et al’s retrospective study20 supported the CBE tool for screening. The results revealed that of the 6,333 can-cers, 54.8% (n ¼ 3,470) were discovered by mammography screening and CBE, 8.7% (n ¼ 551) were found by physician-performed CBE alone (5.3% if considering ultrasonography), and 36.5% (n ¼ 2,312) were detected by mammography screening alone.20 The study concluded that if CBE was not performed, a significant number of cancers would have been missed. CBE is a low-cost test that may prompt further testing such as breast ul-trasonography when a negative mammogram result is found.20
    Diagnostic Tests for Breast Cancer
    The USPSTF guidelines did not recommend using ultrasonog-raphy (USG) or MRI to screen for early detection of breast cancer. Mainstay imaging is mammography for screening. NPs can use USG or MRI tests as supplemental imaging to rule out a breast cancer diagnosis.
    Radiation-induced breast cancer, testing anxiety, and a potential delay in cancer diagnosis are concerns with mammogram screening. In the US, approximately 10% of women were recalled for further testing, and 0.5% of them were diagnosed with breast cancer.13 False-negative findings have been reported in 6% to 46% of mammograms.13