Page 66 Complete Your CE Test Online - Click Here Table 4: Breast Imaging Reporting and Database System (BI-RADS). Adapted from National Cancer Institute, 2014 Mammograms [175]. Category Assessment Follow-up 0 Need additional imaging evaluation. Additional imaging needed before a category can be assigned. 1 Negative. Continue regular screening mammograms (for women over age 40). 2 Benign (noncancerous) finding. Continue regular screening mammograms (for women over age 40). 3 Probably benign. Receive a six-month follow-up mammogram. 4 Suspicious abnormality. May require biopsy. 5 Highly suggestive of malignancy. Requires biopsy. No screening for male breast cancer Note that, even though men develop breast cancer, male breast cancer occurs at a rate about one percent of that of women. There are no recommendations to screen men for breast cancer. However, men should be informed that they can get breast cancer, rare though it is. Men should report lumps, changes, and thickening in the nipple, breast, and armpit to their health care providers and seek prompt medical attention for any new growths or changes to the breast area. Diagnostic mammograms Mammograms that are used to check for breast cancer after a lump or other sign or symptom of it are no longer called screening mammograms. These follow-up exams are called diagnostic mammograms. They are coded and billed differently, so that the patient whose health plan does not require out-of-pocket payments for a screening mammogram may have a co-pay for a diagnostic one. Besides a lump, reasons for diagnostic mammograms can include: ● ● Breast pain. ● ● Thickening or other changes of breast skin. ● ● Nipple discharge. ● ● Change in breast size or shape. ● ● Evaluate changes found during a screening mammogram. ● ● View of breast tissue when a screening mammogram is difficult because of special circumstances, such as the presence of breast implants. Diagnostic mammograms can help determine if and where a biopsy is needed [175]. Future technologies for breast cancer screening The National Cancer Institute is supporting the development of several new technologies to detect breast tumors, and other research continues to look at fine-tuning breast cancer screening. This research ranges from methods being developed in research labs to those that are being studied in clinical trials. Efforts to improve conventional mammography include magnetic resonance imaging (MRI), positron emission tomography (PET) scanning, and diffuse optical tomography, which uses light instead of x-rays to create pictures of the breast [175]. Cervical cancer screening for women 21 and older Pap smears and human papillomavirus (HPV) testing reduce the incidence of cervical cancer because they allow abnormal cells to be identified and treated before they become cancer. Testing is generally recommended to begin at age 21 and to end at age 65 for women of average risk, as long as recent tests had adequate samples and normal results [254]. More details on each screening test follow. Evidence-based practice: Pap and HPV testing have been proven to reduce deaths from cervical cancer. These are started in women of average risk at age 21 and typically continue at 3-5 year intervals, depending on testing method used, through age 65 [191]. The USPSTF reports strong evidence for the following recommendations for screening for cervical cancer for women at average risk: ● ● Women aged 21 to 65 years should be screened with cytology (Pap) every three years. ● ● Women aged 30 to 65 years who want a longer screening interval can be screened with a Pap plus HPV testing every five years. The USPSTF recommends against screening: ● ● With HPV testing in women younger than 30. ● ● Women younger than 21. ● ● Women older than 65 at average risk of cervical cancer whose tests have been normal in the previous ten years, assuming they have had adequate testing. ● ● Women who have had a hysterectomy with removal of the cervix if they have never had a high-grade precancerous lesion (CIN2 or CIN3) or cervical cancer [289]. The American Cancer Society recommendations are quite similar. Although they prefer HPV testing plus Pap every five years in average-risk women aged 30-65, they note that the Pap alone is acceptable if used every three years. The ACS further adds that HPV-vaccinated women should follow the same age-specific recommendations as unvaccinated women at average risk [254]. The above recommendations do not apply to women at high risk of cervical cancer, such as immunocompromised women (e.g. HIV-infected or post-organ transplant), women who were exposed to the drug DES, or those who have had cervical cancer or a high- grade cervical lesion in the past. These individuals might need more intensive screening, or other alternative screening based on their condition or situation [254,289]. Pap test Regular screening (with removal of precancerous cells) in women aged 21 to 65 for cervical cancer with the Pap test reduces cervical cancer incidence and mortality by at least 80% compared to no screening [150]. The benefits of screening women younger than 21 years are small because of the low prevalence of lesions that will progress to invasive cancer. Screening has not proven beneficial in women older than 65 years if they have had recent negative tests [104]. Studies that compare the Pap test against repeat Pap testing have found that the sensitivity of any abnormality on a single test for detecting high-grade lesions is 55-80% [49,261]. Because of the usual slow- growing nature of cervical cancer, the sensitivity of a program of regular Pap testing is likely higher, i.e. if a cancer is missed on one test the next test is likely to find it [150]. The National Cancer Institute reports that the risk of developing invasive cervical cancer is much greater in women who have not been screened with a Pap test and in women with a long gap after the last normal Pap [150]. But screening every two to three years has not been found to significantly raise the risk of finding invasive cervical cancer more than annual screening [108,112]. Findings on Pap tests: Noninvasive cervical squamous cell abnormalities are graded by the pathologist as CIN 1, CIN 2, or CIN