Toolbox
- Clark Tools
- Multnomah Tools
- BME-Limitation of Liability Program
- Cultural Competency Tools
- Labs & Imaging - By Location
- Notice of Privacy Practices
- Tools for Physicians & Staff
- Medical Referral Guidelines - For Providers
- Allergy-Immunology
- Audiology-Hearing Loss
- Cardiology
- Dermatology
- Ear, Nose, and Throat
- Endocrinology
- Gastroenterology
- General Surgery
- Limb Preservation
- Nephrology
- Neurology
- Neurosurgery
- OB-GYN
- Ophthalmology
- Oral and Maxillofacial
- Orthopedics
- Pediatric Infectious Disease
- Pediatric Pulmonology
- Plastic Surgery
- Podiatry
- Pulmonology - Adult
- Radiology-Mammography
- Rheumatology
- Urology
- Vascular Surgery
- Wound Care (non-healing)
- Washington Tools
- Media Resources
- Pharmacy Program
Radiology-Mammography
Diagnosis/Definition
- Screening mammograms are performed on asymptomatic women.
- These are performed in batch mode and read within 2-3 days.
- If pain is the only complaint, a screening mammogram is the appropriate test to order.
Diagnostic mammograms are performed for a variety of indications:
- Prior personal history of breast cancer
- Implants
- Abnormal physical exam
Diagnostic mammograms require a radiologist in attendance to tailor the patient work-up and to perform ultrasound when appropriate
Initial Diagnosis and Management
- A breast exam by the requesting provider should be performed within 90 days of a mammogram request to ascertain whether a diagnostic or screening mammogram is in order.
- In patients over age 30 with an abnormality on physical exam, a diagnostic mammogram and ultrasound should be obtained.
- In patients under age 30 with an abnormality on physical exam, breast-imaging generally is limited to ultrasound.
- Breast cysts are common and easily treated by aspiration if large and symptomatic. However, attempted aspiration of suspected small or asymptomatic cysts at a primary care level (prior to mammography) is discouraged since such attempts are often unsuccessful, and may hinder mammographic assessment.
Ongoing Management and Objectives
- Well-woman breast health maintenance: Low-risk group women are advised to perform monthly self-exams, to have a yearly professional breast exam, and to obtain their initial screening mammogram sometime between the ages of 35-40. Subsequent screening mammograms are advised annually after age 40.
- Women with a positive family history should follow a similar plan, but should begin annual mammograms 10 years prior to the age that the mother or sister developed breast cancer.
- The primary determinants of high-risk for breast cancer are a prior personal history of breast cancer, a prior breast biopsy showing atypical hyperplasia or lobular carcinoma in situ (LCIS), or having a mother or sister with breast cancer diagnosed prior to age 50.
Indications for Specialty Care Referral
Any concerning breast mass that persists beyond one menstrual cycle should be referred for diagnostic mammography.
Spontaneous unilateral, bloody or clear nipple discharge should be referred for diagnostic mammography.
Nipple or skin inversion or retraction should be referred for diagnostic mammography.
Criteria for Return to Primary Care
Patients who have had a specialty-level breast biopsy of any kind with benign outcome should have a follow-up unilateral mammogram 6 months post biopsy, then resume well-woman breast health surveillance (at the one year interval given age and risk factors) under the supervision of their primary care provider.
