Prevention of breast cancer Afdrukken
do 02.10.2008
published in Huisarts Nu 2008; 37 (1): 2-27 

 

  • Mammography screening participation reduces breast cancer mortality (evidence level 1). GPs must ensure that women in the target group for breast cancer screening (all women between 50 and 69 years of age) are screened every two years, by means of a screening mammogram performed at a recognised mammographic unit.·       
  • It is up to GPs to inform women taking part in mammographic screening that this screening test can lead to false-positive and false-negative results (evidence level 1). GPs and patients must remain alert to the possibility that breast cancer occurs in women with normal screening results, and must take the necessary steps for appropriate diagnosis if symptoms or abnormalities occur (evidence level 1). GPs also play an important role in the psychosocial care of women faced with a (false-) positive screening mammogram (evidence level 3).·       
  • Women younger than 50 rarely benefit from mammographic screening (evidence level 1). If a woman with no family risks requests screening at a relatively young age, it is up to the GP to inform her that the potential benefit will be limited (evidence level 1). The woman must also be told about the possible negative consequences of such a screening test, i.e. that there is a much greater chance of false-positive or false-negative results than in the older age category (evidence level 1).·       
  • Screening can also reduce breast cancer mortality in patients over 69 years of age (evidence level 1). Age is not a reason for stopping participation in screening. In the elderly, lower life expectancy and higher comorbidity play an important role; the beneficial effects of screening are not seen until after ten years. Given the high female life expectancy, many guidelines consider an age limit of 75 years to be justifiable for women with no serious comorbidity (evidence level 2).·       
  • In women younger than 50 expressing concern about breast cancer, it is up to the GP to identify women with a family risk (evidence level 2). Such family history is also systematically indicated in women over 35 years still using oral contraceptives or in women on long-term hormone replacement therapy (evidence level 2). For women with a high risk for breast cancer, there is evidence that MRI screening up to the age of 40 years is useful, followed by an annual screening mammography from 40 years of age upwards (evidence level 3). Women with a high risk should be referred to a centre for genetic counselling (evidence level 3).·       
  • It is up to the GP to instruct women on ‘breast awareness’. Women should be urged to get to know their own breasts and to constantly pay attention to any breast changes (evidence level 3). For this, regular breast examination by women is essential. However, routine examination at a fixed monthly time, according to a well-defined schedule, is pointless. It is no longer the task of GPs to give women specific training and to urge them to carry out conventional monthly breast self-examination (evidence level 1).·       
  • There is no need for a systematic clinical breast examination for women with no increased family risk who are referred for a screening mammography (evidence level 1). Appropriate clinical breast examination is indicated only in women consulting their doctor for manifest breast complaints or clinical symptoms. Clinical testing should lead to diagnostic mammography and ultrasound and not to screening mammography.
Laatst aangepast: di 25.05.2010