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Breast Cancer Screening

Part 1: Introduction

Part 2: Characteristics for Success: Breast Cancer Screening

Part 3: Implementation of Quality Measure: Breast Cancer Screening 

Part 4: Improvement Strategies: Breast Cancer Screening

Part 5: Holding the Gains and Spreading Improvement

Part 6: Supporting Information

Part 6: Supporting Information 

Case Study
To gain insight into how one QI team approached this measure, review a case study highlighting Green Valley Family Health Center's approach to improving Breast Cancer Screening performance.
References
  1. Cancer statistics, 2009. Jemal A; Siegel R; Ward E; Hao Y; Xu J; Thun MJ CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49. Epub 2009 May 27.
  2. Lifetime Risk (Percent) of Being Diagnosed with Cancer by Site, Race and Sex, 12 SEER Areas, 1998-2000 [PDF | 135KB]
  3. Arslan, AA, Formenti, SC. Mammography in developing countries: the risks associated with globalizing the experiences of the Western world. Nat Clin Pract Oncol 2009; 6:136. 
  4. American Cancer Society Breast Cancer Facts and Figures 2008 Exit Disclaimer.
  5. Race, socioeconomic status, and breast cancer treatment and survival. Bradley CJ; Given CW; Roberts C J Natl Cancer Inst 2002 Apr 3;94(7):490-6
  6. American Cancer Society Breast Cancer Facts and Figures 2008 Exit Disclaimer.
  7. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. AU Carey LA; Perou CM; Livasy CA; Dressler LG; Cowan D; Conway K; Karaca G; Troester MA; Tse CK; Edmiston S; Deming SL; Geradts J; Cheang MC; Nielsen TO; Moorman PG; Earp HS; Millikan RC SO JAMA. 2006 Jun 7;295(21):2492-502.
  8. Berry, DA, Cronin, KA, Plevritis, SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353:1784.
  9. Smith-Bindman, R, Miglioretti, DL, Lurie, N, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer?. Ann Intern Med 2006; 144:541.
  10. Sturgeon, SR, Schairer, C, Gail, M, et al. Geographic variation in mortality from breast cancer among white women in the United States. J Natl Cancer Inst 1995; 87:1846.
  11. Moss SM, Cuckle H, Evans A, et al.: Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial. Lancet 368 (9552): 2053-60, 2006.
  12. American Academy of Family Physicians. A-E: recommendations for clinical preventive services. Leawood, Kan: American Academy of Family Physicians; 2009.Exit Disclaimer.
  13. Diagnostic performance of digital versus film mammography for breast-cancer screening. Pisano ED; Gatsonis C; Hendrick E; Yaffe M; Baum JK; Acharyya S; Conant EF; Fajardo LL; Bassett L; D'Orsi C; Jong R; Rebner M N Engl J Med 2005 Oct 27;353(17):1773-83. Epub 2005 Sep 16.
  14. Tailored supplemental screening for breast cancer: what now and what next? AU Berg WA SO AJR Am J Roentgenol. 2009 Feb;192(2):390-9
  15. Bobo, JK, Lee, NC, Thames, SF. Findings from 752 081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 2000; 92:971.
  16. Breast self-examination in relation to the occurrence of advanced breast cancer. AU Newcomb PA; Weiss NS; Storer BE; Scholes D; Young BE; Voigt LF SO J Natl Cancer Inst 1991 Feb 20;83(4):260-5.
  17. Saslow D, Boetes C, Burke W et al. American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA—A Cancer Journal for Clinicians. 2007;57:75-89.
  18. Alfonso, Nelia; Women at High Risk for Breast Cancer—What the Primary Care Provider Needs to Know The Journal of the American Board of Family Medicine 22 (1): 43-50 (2009) Exit Disclaimer.
  19. Smith, RA, Cokkinides, V, Brawley, OW. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 2009; 59:27.
  20. ACR Practice Guidelines for the Performance of Screening and Diagnostic Mammography Exit Disclaimer.
  21. American Medical Association Exit Disclaimer.
  22. National Cancer Institute: Breast Cancer Screening
  23. American College of Obstetricians and Gynecologists. Primary and preventive care: Periodic assessments. ACOG Committee Opinion 246. Washington, DC: ACOG, 2000.
  24. Bevers, TB, Anderson, BO, Bonaccio, E, et al. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Screening and Diagnosis. J Natl Compr Canc Netw 2009; 7:1060.
  25. Periodic Health Examinations: Summary of AAFP Policy Recommendations & Age Charts.Exit Disclaimer. (Accessed March 7, 2005).
  26. Nelson, HD, Tyne, K, Naik, A, et al. Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151:727
  27. Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003 Mar 15;97(6):1528-1540
  28. HRSA Budget Web site
  29. Taplin S et al, Medical Care, V46(9) supplement1:S74-S83
  30. Institute of Medicine. Breakthrough Series College Aim Statement Checklist Boston: Institute for Healthcare Improvement. February 2004  
  31. 2008 State of Health Care report.
  32. Adapted from pre-work manual used in HRSA sponsored Health Disparities Collaborative Exit Disclaimer.
  33. NQC "A Guide to Consumer Involvement" Exit Disclaimer.
  34. Timmermans S, Mauck A (2005). The promises and pitfalls of evidence-based medicine. Health Aff (Millwood) 24 (1): 18–28. doi:10.1377/hlthaff.24.1.18. PMID 15647212.
  35. American Cancer Society Guidelines for Early Breast Cancer Detection, 2003
  36. Institute of Medicine. Envisioning the National Healthcare Quality Report. 2000. Washington, DC, National Academy of Sciences.
  37. Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States
  38. Adapted from Chronic Care Model.
  39. Langley G., Nolan K., Nolan T., Norman C., Provost L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco. Jossey-Bass, 1996.
Additional Resources
  1. Mandelblatt, JS, Cronin, KA, Bailey, S, et al. Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms. Ann Intern Med 2009; 151:738. Good discussion of risks and benefits
  2. AHRQ Prevention and Care Management
  3. AHRQ Prevention and Care Management Resources and Materials
  4. Saslow D, Hannan J, Osuch J, et al. Clinical breast examination: practical recommendations for optimizing performance and reporting. CA Cancer J Clin. 2004;54:327-344. [PMID: 15537576]
  5. Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 1999;282:1270-1280. [PMID: 10517431]
  6. Baron RC, Rimer BK, Breslow RA, et al; Task Force on Community Preventive Services. Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening a systematic review. Am J Prev Med. 2008;35:S26-S66.
  7. U.S. Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med. 2002;137:344-346. [PMID: 12204019]
  8. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727-737.
  9. American Cancer Society. How many women get breast cancer? Overview: breast cancer. Atlanta, Ga: American Cancer Society; 2009. Exit Disclaimer.
  10. National Cancer Institute. Surveillance Epidemiology and End Results. SEER stat fact sheets: breast cancer. Bethesda, Md: National Cancer Institute; 2009.
  11. Horner MJ, Ries LAG, Krapcho M, et al, eds. Surveillance Epidemiology and End Results. SEER cancer statistics review, 1975-2006, National Cancer Institute. Bethesda, Md: National Cancer Institute; 2009.
  12. Breast Cancer Surveillance Consortium. Evaluating screening performance in practice. [PDF | 935KB]Bethesda, Md: National Cancer Institute; 2004.
  13. Pisano ED, Gatsonis C, Hendrick E, et al; Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group.
  14. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005;353:1773-1783. [PMID: 16169887]
  15. Kriege M, Brekelmans CT, Boetes C, et al; Magnetic Resonance Imaging Screening Study Group. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351:427-437. [PMID: 15282350]
  16. Recommendation Statement From USPSTF: Screening for Breast Cancer Exit Disclaimer. 12 of 13 1/3/2010 4:03 PM
  17. Nelson HD, Tyne K, Naik A, et al. Screening for Breast Cancer: Systematic Evidence Review Update for the U.S. Preventive Services Task Force. Evidence Synthesis No. 74. Rockville, Md: Agency for Healthcare Research and Quality; 2009. AHRQ publication 10-05142-EF-1.
  18. National Cancer Institute. Effect of screening on breast cancer mortality. Atlanta, Ga: National Cancer Institute; 2009.
  19. American Cancer Society. American Cancer Society Guidelines for the Early Detection of Cancer. Atlanta, Ga: American Cancer Society; 2009.Exit Disclaimer.
  20. American Medical Association. H-525.993. Mammography screening in asymptomatic women forty years and older. Chicago, Ill: American Medical Association; 2002.
  21. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology™: breast cancer, v.1.2009 [Registration Required]. Fort Washington, Pa: National Comprehensive Cancer Network; 2009. Exit Disclaimer.
  22. American Academy of Family Physicians. A-E: recommendations for clinical preventive services. Leawood, Kan: American Academy of Family Physicians; 2009. Exit Disclaimer.
  23. Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146:511-5155.
  24. Ringash J; Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: screening mammography among women aged 40-49 years at average risk of breast cancer. CMAJ. 2001;164:469-476.
  25. (ACOG) American College of Obstetricians and Gynecologists. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 42, April 2003. Breast cancer screening. Obstet Gynecol. 2003;101:821-831. [PMID: 12685457]
  26. World Health Organization. Screening for breast cancer. Geneva, Switzerland: World Health Organization, 2009. Exit Disclaimer.
  27. National Cancer Institute: Breast Cancer Screening Exit Disclaimer. - Patient information from the NCI regarding breast cancer screening.
  28. National Cancer Institute: What is screening? Exit Disclaimer. - HealthProfessional PDQ information for health professionals provides peer reviewed ongoing updates for topics regarding cancer for health professionals that is updated on an ongoing basis.


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