configs/knowledge_base/dx_protocols/mammography_screening.yaml

key: mammography_screening
name: "Mammogram for Breast Cancer Screening"
description: "A mammogram is a low-dose X-ray of the breast used to find early signs of cancer, often before they can be seen or felt as a lump. Finding breast cancer early greatly increases the chances of successful treatment."
typical_frequency: "Every 1 to 2 years for women of screening age, depending on specific guidelines and risk factors."
additional_information: |
  #### CORE GUIDANCE FOR AVERAGE-RISK INDIVIDUALS
  This information is for individuals at average risk of breast cancer. You are generally considered average risk if you do not have a personal history of breast cancer, a known high-risk genetic mutation like BRCA1/2, or a history of radiation therapy to the chest at a young age.

  ##### Guideline Nuances:
  It's important to know that different expert groups have slightly different recommendations. This can be confusing, but it reflects that they weigh the benefits and harms of screening differently.
  - **U.S. Preventive Services Task Force (USPSTF):** Recommends a mammogram every 2 years for women ages 40 to 74.
  - **American Cancer Society (ACS):** Recommends women ages 40-44 have the option to start yearly mammograms. It recommends yearly mammograms for women 45-54. At age 55, women can switch to every 2 years or continue yearly screening.
  - **NHS (UK):** Invites women for a mammogram every 3 years between the ages of 50 and 71.
  This assistant's primary logic is based on the USPSTF guidelines, which recommend starting at age 40. You should discuss with your doctor which schedule is best for you, considering your personal health, values, and local practices.

  #### RISK STRATIFICATION: IDENTIFYING HIGH-RISK INDIVIDUALS
  Certain factors place you at a significantly higher risk for breast cancer and mean you need a different, more intensive screening plan. If any of the following apply to you, the standard recommendations are NOT sufficient. You should speak with your doctor about a referral to a high-risk breast clinic or genetic counselor.

  ##### High-Risk Triggers:
  - **Known Genetic Mutation:** You or a first-degree relative (parent, sibling, child) have a known mutation in a gene like *BRCA1*, *BRCA2*, *TP53*, *PALB2*, etc..
  - **Strong Family History:** Even without genetic testing, a strong family history may qualify you for high-risk screening. This can be complex, but often includes having multiple first-degree relatives with breast cancer, or relatives diagnosed at a young age (e.g., before 50).
  - **Calculated Lifetime Risk:** Risk assessment tools (like the Tyrer-Cuzick or Gail models) estimate your lifetime risk of breast cancer to be 20% or higher.
  - **History of Chest Radiation:** You received radiation therapy to the chest between the ages of 10 and 30 (e.g., for Hodgkin lymphoma).
  - **Personal History:** You have a personal history of lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH).

  **If you meet high-risk criteria, guidelines often recommend annual screening with both a breast MRI and a mammogram, typically starting at age 30.**

  #### KEY CONSIDERATIONS & ALTERNATIVE OPTIONS

  ##### Breast Density:
  Breast density refers to the amount of fibrous and glandular tissue in a breast compared to fatty tissue. Nearly half of all women have dense breasts.
  - **What it means:** Having dense breasts is common and is a risk factor for breast cancer. It can also make it harder for mammograms to detect cancer, as both dense tissue and tumors can appear white on an X-ray.
  - **Supplemental Screening:** Because of this, there is ongoing research into whether additional tests, like a breast ultrasound or MRI, could help find cancers missed by mammography in women with dense breasts. Currently, the USPSTF states there is not enough evidence to make a recommendation for or against these extra tests for women at average risk. This is an important topic to discuss with your doctor.

  ##### Alternative Mammography Technology:
  - **3D Mammography (Digital Breast Tomosynthesis or DBT):** This is an advanced type of mammogram that takes pictures of the breast from multiple angles to create a 3D-like image. Studies show it can find slightly more cancers and reduce the number of "false alarms" (when you are called back for more testing for something that isn't cancer), especially in women with dense breasts. Both 2D and 3D mammography are considered effective screening methods.

  ##### Benefits and Harms of Screening:
  - **Benefit:** The main benefit of screening is finding cancer early, when it is most treatable and curable.
  - **Harms:** Screening is not perfect. It can lead to:
    - **False Positives:** A result that looks like cancer but is not. This leads to anxiety and the need for more tests (like biopsies).
    - **Overdiagnosis:** Finding and treating cancers that are so slow-growing they would never have caused a problem in a person's lifetime.
    - **Radiation Exposure:** Mammograms use a very low dose of radiation. The benefit of finding cancer early is widely believed to outweigh this small risk.

  ##### Breast Awareness:
  Screening tests are important, but they don't find every cancer. It's crucial to be familiar with how your breasts normally look and feel. If you notice any changes—such as a new lump, skin dimpling, nipple changes, or persistent pain—see a doctor right away, even if your last mammogram was normal.