HIGH RISK

• High risk is defined as >20-25% lifetime risk of developing CA

• Intermediate risk is defined as 15-20% risk of developing CA and includes:

  • A personal hx of breast CA 

  • H/o ADH/ALH or LCIS

  • ACS states there is not enough evidence to recommend for or against screening breast MR. 

BRCA 1/2 CARRIERS

• BRCA 1/2 genes regulate DNA-damage response and repair in the cell.

• Annual screening breast MR should begin by age 25.

  • Not yet shown to reduce deaths 2/2 breast CA

• Ppx mastectomy significantly reduces (90%) but does not eliminate breast CA risk 

  • Can be found in axillary nodes and residual breast tissue post mastectomy

LACTATING WOMEN

• 3% of breast CA are diagnosed in pregnancy

• Hormonal changes during pregnancy lead to increased: breast size, firmness, nodularity, parenchymal density

• For symptomatic lactating women, begin with US initially. However, mammography can and should be used when necessary as suspicious findings should be completely characterized.

• For screening, ideally wait 2-3 months after discontinuing lactation to perform mammography.

• DDX for  breast mass in lactating patient: galactocele, lactating adenoma, abscess, focal mastitis, breast CA

• Start with FNA if you are suspicious to prevent milk fistula formation and preventign them from breast feeding.