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Breast Imaging Guidelines

Following are clinical guidelines related to breast imaging exams.
 
Screening Mammography

30 min appointment
 
Does not require a health care provider order. Patients may schedule directly.
  • Medicare requires a minimum 12 months interval between screening mammogram 
  • Routine, annual, asymptomatic, no new problems 
  • Annually after age 40 Average Risk 
  • Annually after age 30 for High Risk Surveillence. The new guideline is published in the latest issue of the ACS journal CA: A Cancer Journal for Clinicians. It recommends MRI screening in addition to mammograms for women who meet specified conditions. 
  • Family History of Breast Cancer 
  • Personal History of Breast Cancer not undergoing current treatment
  • History of implants without new problems
Diagnostic Mammography and possible Ultrasound as needed

1–2 hour appointment
 
Please specify location, level of suspicion and description of any abnormalities.
  • Symptomatic patient with new dominant mass, lump, thickening or asymmetry 
  • Focal non-cyclic pain 
  • New onset spontaneous nipple discharge or nipple changes 
  • Personal History of Breast Cancer undergoing current treatment 
  • Implant problem 
  • Additional imaging needed or follow-up mammogram (BIRADS 0 or 3)
Diagnostic Breast Ultrasound and possible Diagnostic Mammography as needed

1–2 hour appointment
 
Please specify location, level of suspicion and description of any abnormalities.
  • Less than 30 years old with new dominant mass, lump or focal non-cyclic pain
  • At any age with recent normal mammogram but new clinical findings
  • Additional imaging needed or follow-up ultrasound (BIRADS 0 or 3)
Galactogram / Ductogram

1–2 hour appointment

Surgical assessment recommended prior to scheduling.

Please specify location of abnormal duct orifice.


Please note that discharge must be expressed at the time of procedure for successful cannulation.

  • New onset of unilateral reproducible single duct spontaneous serous or bloody nipple discharge
Breast MRI

1–2 hour appointment

May require insurance pre-authorization. Requires injection of IV contrast.
  • Additional evaluation of persistent indeterminate clinical, mammography or ultrasound abnormality 
  • High-risk surveillance. It has been suggested that Breast MR may be obtained 6 months after annual screening mammogram. The new guideline is published in the latest issue of the ACS journal CA: A Cancer Journal for Clinicians. It recommends MRI screening in addition to mammograms for women who meet at least one of the following conditions:
    • they have a BRCA1 or BRCA2 mutation 
    • they have a first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if they have yet to be tested themselves 
    • their lifetime risk of breast cancer has been scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors such as BRACAPRO 
    • they had radiation to the chest between the ages of 10 and 30 greater than 4 Gy 
    • they have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or may have one of these syndromes based on a history in a first-degree relative
  • Possible inflammatory cancer
  • Silicone Implant evaluation
  • Staging and extent of newly diagnosed breast cancer and contralateral disease for treatment planning
  • Not recommended for follow up of previous treated breast cancer 
  • Not recommended to follow up high risk lesions such as Atypia, LCIS, ALH, ADH diagnosed on previous biopsy 
  • Not recommended for average risk women

Second Opinion on Non-UW Health Mammogram

Must be submitted by a UW Breast Center health care provider for patients undergoing current care. Please state clinical question to be answered on the order. Original mammogram images along with original radiology reports are required for interpretation. Other comparison images may also be helpful.

Additional information can be obtained on the NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Screening and Diagnosis Guidelines at www.nccn.org.