Mammogram

Educate the patient regarding the importance of obtaining a yearly mammogram and Papanicolaou (Pap) smear (if applicable), as well as performing a monthly breast self-examination. 

Initial work-up for a woman presenting with a lesion or symptoms suggestive of breast cancer should include a careful history, physical examination of the breast, three-dimensional mammography, and possibly other breast imaging techniques such as ultrasound. Most (80% to 85%) breast cancers can be visualized on a mammogram as a mass, a cluster of calcifications, or a combination of both. Breast biopsy is indicated for... 

CBE Age 20-30 every 3 years Age greater than or equal to 40 every year All ages (recommended with mammogram) All ages every year... 

Patients on DMPA also should be weighed, have their blood pressure monitored, and have a physical exam, and Papanicolaou smear annually, as well as mammogram as indicated based on the patient s age. 

With estrogen-based therapy, there should be yearly breast exams, monthly breast self-examinations, and periodic mammograms. Women on hormonal therapy should undergo annual monitoring, including pelvic examination, blood pressure checks, and routine endometrial cancer surveillance. 

Nordenstrom and his coworkers have also applied ECT to breast cancer17 of a patient. Two years after the treatment, mammograms, taken at six-month intervals, could not detect any remaining tumors. 

Suppose that a woman has a positive mammogram. What is the probability that she in fact has breast cancer To solve this problem statisticians use Bayes Theorem, a theorem in conditional probability introduced by the non-conformist minister the Reverend Thomas Bayes in 1763. Gigerenzer explains how Bayes theorem works by converting the problem into natural frequencies. ... 

If there are 100000 asymptomatic patients in the population, then 800 will have breast cancer (0.8%-l). Of these, 720 (90%-2) will have a positive mammogram. The remaining 99200 women do not have breast cancer, but 6944 (7%-3) will nonetheless have a positive mammogram. Therefore, in total 7664 women will have a positive mammogram, of which 720 would in reality have breast cancer. Thus the probability that a woman with a positive mammogram has breast cancer is 720/7644 = 9.4%. 

Close clinical surveillance of all women taking OCs is essential they should be reexamined at least once a year. In all cases of undiagnosed persistent or recurrent abnormal vaginal bleeding, rule out malignancy. Monitor women with a strong family history of breast cancer or who have breast nodules, fibrocystic disease of the breast, cervical dysplasia, or abnormal mammograms. 

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