Good Health Blog

Keeping abreast of recommendations

- September 27, 2011

There are varying levels of ‘recommendations’ that come down from the many medical bodies. Some are based on hard scientific evidence and studies (called a grade A recommendation) through those with limited and inconsistent scientific evidence (level B) to a ‘consensus of expert opinion’ (a grade C recommendation).

There is sometimes debate – event heated – about the grade C recommendations between various medical groups. What the public hears is usually what the press bothers to report.

Of interest this week is the most recent recommendations on breast cancer screening from the Agency for Healthcare Research and Quality.

The following recommendations are based on limited and inconsistent scientific evidence (Level B):

* Based on the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential reduction in breast cancer mortality, the College recommends that women aged 40 years and older be offered screening mammography annually.

The following recommendations are based primarily on consensus and expert opinion (Level C):

* Clinical breast examination should be performed annually for women aged 40 years and older.
* For women aged 20–39 years, clinical breast examinations are recommended every 1–3 years.
* Breast self-awareness should be encouraged and can include breast self-examination. Women should report any changes in their breasts to their health care providers.
* Women should be educated on the predictive value of screening mammography and the potential for false-positive results and false-negative results. Women should be informed of the potential for additional imaging or biopsies that may be recommended based on screening results.
* Women who are estimated to have a lifetime risk of breast cancer of 20% or greater, based on risk models that rely largely on family history (such as BRCAPRO, BODACEA, or Claus), but who are either untested or test negative for BRCA gene mutations, can be offered enhanced screening.
* Breast magnetic resonance imaging (MRI) is not recommended for screening women at average risk of developing breast cancer.
* For women who test positive for BRCA1 and BRCA2 mutations, enhanced screening should be recommended and risk reduction methods discussed.

Some of the above is ‘medical speak’ and for a more detailed explanation the links in the subscribers area for those in the risk cateogories go further to explain the genetic risks.