NCCN org Version 1 2019 05 17 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Breast Cancer Screening and Diagnosis Version 1 2019 May 17 2019 Continue Therese B Bevers MD Chair The University of Texas MD Anderson Cancer Center Mark Helvie MD Vice Chair University of Michigan Rogel Cancer Center Ermelinda Bonaccio MD Roswell Park Comprehensive Cancer Center Kristine E Calhoun MD University of Washington Seattle Cancer Care Alliance Melissa Camp MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Mary B Daly MD PhD Fox Chase Cancer Center Constance Dobbins Lehman MD PhD Massachusetts General Hospital Cancer Center William B Farrar MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Judy E Garber MD MPH Dana Farber Brigham and Women s Cancer Center Richard Gray MD Mayo Clinic Cancer Center Randall E Harris MD PhD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Teresa Helsten MD UC San Diego Moores Cancer Center Linda Hodgkiss MD St Jude Children s Research Hospital The University of Tennessee Health Science Center Tamarya L Hoyt MD Vanderbilt Ingram Cancer Center John G Huff MD Vanderbilt Ingram Cancer Center Maxine S Jochelson MD Memorial Sloan Kettering Cancer Center Bethany L Niell MD PhD Moffitt Cancer Center Catherine C Parker MD O Neal Comprehensive Cancer Center at UAB Mark Pearlman MD University of Michigan Rogel Cancer Center Liane Philpotts MD Yale Cancer Center Smilow Cancer Hospital Donna Plecha MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Jennifer K Plichta MD MS Duke Cancer Institute Mary Lou Smith JD MBA Research Advocacy Network Roberta M Strigel MD MS University of Wisconsin Carbone Cancer Center Lusine Tumyan MD City of Hope National Medical Center Cheryl Williams MD Fred cephalad caudad from clavicle to inframammary ridge axilla and clavicular lymph node basins Time spent on the palpable portion of the exam is associated with increased detection of palpable abnormalities Clock quadrant location and distance from nipple facilitate geographic correlation with imaging findings 5th bullet modified For women with mammographically dense breast tissue heterogeneously or extremely dense breast tissue recommend counseling on the risks and benefits of supplemental screening 6th bullet modified Dense breasts limit the sensitivity of mammography Mammographically dense breast tissue is associated with an increased risk for breast cancer 8th bullet modified Multiple studies show that tomosynthesis can decrease call back rates and appears to improve cancer detection Of note most studies used double the dose of radiation The radiation dose can be minimized by using synthesized 2 D reconstruction 9th bullet modified Hand held or automated ultrasound can increase cancer detection rates in women with dense breast tissue but may increase recall and benign breast biopsies 10th bullet modified Current evidence does not support the routine use of molecular imaging eg breast specific gamma imaging sestamibi scan or positron emission mammography as screening procedures but there is emerging evidence that these tests may improve detection of early breast cancers among women with mammographically dense breasts However the whole body effective radiation dose with these tests is between 20 30 times substantially higher than that of mammography 12th bullet modified MRI in these select populations References 1 4 have been moved to the Discussion Section BSCR A 2 of 2 1st bullet under Recommend Annual MRI Screening Based on Evidence modified First degree relative of BRCA breast cancer genetic mutation carrier but untested 3rd bullet under Insufficient Evidence to Recommend for or Against MRI Screening deleted Women with a personal history of breast cancer including ductal carcinoma in situ DCIS BSCR B 4th bullet modified Number of female first degree relatives with breast cancer Footnotes 3rd reference modified The current Gail Model may not accurately assess breast cancer risk in non Caucasian non Asian and non Africian American women It is not an appropriate model for assessing lifetime risk in women with a strong family history of breast and related cancers NCCN Guidelines Version 1 2019 Breast Cancer Screening and Diagnosis Version 1 2019 05 17 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 5 19 2019 10 26 11 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensi