Abnormal screening results

This module has reviewed some of the more frequently used procedures for managing abnormal breast cancer screening results and making an initial diagnosis of breast cancer. Below is a quick review of recommendations for follow-up of abnormal breast cancer screenings.

Breast exam with palpable mass & < 30 years: Recommended follow-up

Ultrasound (preferred by NCCN, recommended by ACR), or
Needle sampling, or
Observe for 1-2 menstrual cycles, if low clinical suspicion (NCCN, 2004), (ACR, 2003c)

Breast exam with palpable mass & > 30 years: Recommended follow-up

Diagnostic mammogram, preferred, or
Ultrasound, if suspected simple cyst or during pregnancy (NCCN, 2004), (ACR, 2003c)

Screening mammogram with suspicious findings & breast exam negative (non-palpable): Recommended follow-up

Diagnostic mammogram (helpful with calcifications)
+/- Ultrasound (helpful to differentiate cyst vs. solid mass) (NCCN, 2004), (ACR, 1996, 2003a)

Diagnostic mammogram with suspicious abnormality (BI-RADS 4) & breast exam negative (non-palpable): Recommended follow-up

Needle biopsy preferred (e.g., core biopsy, or fine needle aspiration if palpable mass), or
Excisional biopsy with needle localization (NCCN, 2004), (ACR, 1996, 2003a)

Important reminders

Even though breast imaging has greatly improved, no one technique is 100% sensitive or 100% specific for detection of breast cancer lesions.

Breast exam with suspicious findings + negative mammogram or ultrasound → further evaluation is recommended (e.g., fine needle aspiration, biopsy or excision) to rule out breast cancer.
Breast exam is negative + suspicious screening mammogram → further evaluation is recommended (e.g., additional diagnostic imaging).

Failure to detect breast cancer is reported to be the most frequent reason for malpractice claims in the U.S.


	Summary
Overview Evaluation of abnormal exams & mammograms Risk management Summary Additional resources & References Quiz	This module has reviewed some of the more frequently used procedures for managing abnormal breast cancer screening results and making an initial diagnosis of breast cancer. Below is a quick review of recommendations for follow-up of abnormal breast cancer screenings. Breast exam with palpable mass & < 30 years: Recommended follow-up Ultrasound (preferred by NCCN, recommended by ACR), or Needle sampling, or Observe for 1-2 menstrual cycles, if low clinical suspicion (NCCN, 2004), (ACR, 2003c) Breast exam with palpable mass & > 30 years: Recommended follow-up Diagnostic mammogram, preferred, or Ultrasound, if suspected simple cyst or during pregnancy (NCCN, 2004), (ACR, 2003c) Screening mammogram with suspicious findings & breast exam negative (non-palpable): Recommended follow-up Diagnostic mammogram (helpful with calcifications) +/- Ultrasound (helpful to differentiate cyst vs. solid mass) (NCCN, 2004), (ACR, 1996, 2003a) Diagnostic mammogram with suspicious abnormality (BI-RADS 4) & breast exam negative (non-palpable): Recommended follow-up Needle biopsy preferred (e.g., core biopsy, or fine needle aspiration if palpable mass), or Excisional biopsy with needle localization (NCCN, 2004), (ACR, 1996, 2003a) Important reminders Even though breast imaging has greatly improved, no one technique is 100% sensitive or 100% specific for detection of breast cancer lesions. Breast exam with suspicious findings + negative mammogram or ultrasound → further evaluation is recommended (e.g., fine needle aspiration, biopsy or excision) to rule out breast cancer. Breast exam is negative + suspicious screening mammogram → further evaluation is recommended (e.g., additional diagnostic imaging). Failure to detect breast cancer is reported to be the most frequent reason for malpractice claims in the U.S.

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Summary