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turn up the pink: OCTOBER IS NATIONAL BREAST CANCER AWARENeSS MONTH

pink ribbon For the past 35 years, National Breast Cancer Awareness Month (NBCAM) has been devoted to educating and empowering women to take charge of their breast health. The NBCAM mission is to help those affected by breast cancer through early detection, education and support services. 

According to the National Breast Cancer Foundation, Inc., the pink breast cancer ribbon has become the universal symbol of breast cancer, illustrating the cause, raising awareness and bringing together women in solidarity. From a simple piece of ribbon affixed with a pin, we are able to show our support for loved ones battling breast cancer and our hope for a brighter future. Encourage your staff to wear a pink ribbon to work every day this month to show your practice's united support for breast cancer awareness.

Quality Insights wants to take this opportunity to thank you for your vital role as a health care provider in guiding women to schedule preventive visits and get recommended mammography.
get the stats: Breast Cancer in Delaware and the U.S. - Successes and Opportunities

delaware icon Breast cancer is the most commonly diagnosed cancer among females and the second most common cause of cancer death among females in both the U.S. and Delaware. A 2019 report from Delaware Health and Social Services, Division of Public Health, details both progress and opportunities:
  • Delaware ranked 9th in the nation for female breast cancer incidence for 2011-2015 (most current available data), compared to 7th nationally in 2010-2014.
  • Incidence rates for female breast cancer increased 6% in Delaware while declining 4% in the U.S. from 2001-2005 to 2011-2015. Incidence rates increased 7% in non-Hispanic Caucasians; 4% in non-Hispanic African-Americans, and 7% in Hispanics for the same comparison periods in the state.
  • The proportion of breast cancers diagnosed in the earliest, most treatable stage has greatly improved in Delaware in the past thirty years. In 1980-1984, 42% were diagnosed at the local stage, compared to 67% in 2011-2015.
  • Delaware's breast cancer mortality rate declined 12% from 2001-2005 compared to 2011-2015, significant progress although less than the 17% national decline. Delaware's breast cancer mortality rate was ranked 21st nationally compared to 20th in the same measurement periods.
  • It is highly likely that improvements in the early detection of breast cancer contributed to Delaware's progress in reduced breast cancer mortality. Data from the 2016 Behavioral Risk Factor Survey showed that Delaware ranked fourth highest nationally in prevalence of females 40 years and older who have had a mammogram within the past two years (72%).
For full details and more information, please see Cancer Incidence and Mortality in Delaware, 2011-2015.
stay in the know: review the current MAMMOGRAPHY GUIDELINES here

provider icon The October emphasis on breast cancer awareness helps engage patients to schedule and complete their mammography screening. They look to you with questions about which type of test they need and the frequency of screening. Various factors including age, breast density, hormone replacement therapy, ethnicity and others can affect the type and frequency of screenings. 

The United States Preventive Services Task Force (USPSTF) guidelines are summarized below. These recommendations are for asymptomatic women ages 40 or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age. For the full recommendations, please visit the Final Recommendation Statement.

USPSTF Recommendations for Asymptomatic Women of Average Risk:

Population
Recommendation
USPSTF Grade
Women age 50-74
Biennial mammography screening
B
Women age 40-49
Decision to start mammography should be individual based on benefit vs. harm. May elect biennial screening.
C
Women age 75 or older
Insufficient evidence to assess balance of benefits and harms.
I
All women
Insufficient evidence to assess the benefits and harms of digital breast tomosynthesis (DBT) as primary screening method.
I
Women with dense breasts
Insufficient evidence to assess balance of benefits and harms of adjunctive screening using ultrasonography, magnetic resonance imaging, DBT or other methods in women with dense breasts on an otherwise negative screening mammogram.
I
 
Screening guidelines vary among different organizations. CDC provides a reference comparing recommendations from seven organizations, including USPSTF, ACS, AAFP, and ACOG.
The Delaware Cancer Consortium, a multi-functional team including medical professionals, recommends following these simple guidelines:
  • Females age 40 and older - annual mammogram and clinical breast exam
  • Females age 18-39 - annual clinical breast exam
october 18, 2019: celebrate national mammography day

mammography Since 1993, the third Friday in October of each year is National Mammography Day. On this day and throughout the month, women are encouraged to make a mammography appointment. Learn more at the National Breast Cancer Foundation  (NBCF) website, where patients can find facilities that offer free mammograms and diagnostic breast care. NBCF requires that medical facilities in its network have capacity to continue treatment after an abnormal finding or diagnosis of breast cancer.
watch it: video highlights mammography guidelines 

Quality Insights offers a fact-filled 13-minute video, hosted by Dr. Edward Sobel, that provides an overview of current breast cancer screening guidelines and recommendations to ensure that your clinical team stays up-to-date on the important topic of mammograms.
screening for life: delaware program offers funds cancer screenings for eligible patients

SFL logo Most health insurance payers now cover mammography every 1-2 years with no out-of-pocket costs. For patients who are uninsured or underinsured, Healthy Delaware offers the Screening for Life program for financial help with mammography and other cancer screenings. 

Patients can call 1.302.744.1040 to speak to a nurse navigator and learn if they are eligible.
what's new & what's next?: 2019 breast cancer screening updates 

free update image New USPSTF Recommendations on BRCA Genetic Testing
In August 2019, the U.S. Preventive Services Task Force (USPSTF) updated its recommendations on risk assessment, genetic counseling, and genetic testing for BRCA (breast cancer)-related cancer, saying that women with either a personal family history of breast or ovarian cancer, as well as women who are Ashkenazi Jewish (Eastern European), should have risk assessed by their primary care doctor. USPSTF recommends a three-step process:
  1. Risk assessment with a validated risk assessment tool by the primary care doctor
  2. Genetic counseling if the risk assessment has positive results
  3. Genetic testing, if indicated after genetic counseling

Combining Breast Density Info with Five-Year Risk Score Helps Determine Need for Additional Screening
Research published in JAMA Internal Medicine in July 2019 recommended that physicians combine breast density information with a woman's five-year breast cancer risk estimate to determine who should have additional screening beyond yearly mammograms. For the full study, read " Strategies to Identify Women at High Risk of Advanced Breast Cancer during Routine Screening for Discussion of Supplemental Imaging."

ACS to Study Breast Cancer Risk Screening Recommendations
The American Cancer Society (ACS) issued a guideline in 2007 for use of MRI screening in women at substantially increased risk for developing breast cancer. Annual screening mammography and magnetic resonance imaging (MRI) starting at age 30 years are recommended for women with a known BRCA mutation, women who are untested but have a first-degree relative with a BRCA mutation, or women with an approximately 20% to 25% or greater lifetime risk based on specialized risk assessments. Annual MRI and mammography are also recommended for women who were treated for Hodgkin disease with chest radiation under age 30 years.

Since these recommendations for women at high risk were published, questions have been raised about the discordances among risk assessment tools, resulting in variable estimates of lifetime risk. According to a review of cancer screening in the United States, 2019, the ACS has commissioned a systematic review of the evidence to inform breast cancer screening recommendations. The review will consider risk and screening outcomes in subgroups of women, including some for whom previously available evidence was not sufficient to support a recommendation for differential screening. The ACS review and the guideline update will address thresholds of risk related to various dominant or combination of risk factors and the appropriate use of available risk-assessment tools.
provider education: take advantage of these online educational opportunities and helpful resources

education icon Medscape Breast Cancer Learning Center - Free CME is available for these web-based educational opportunities on a variety of treatment, prevention, and screening topics.

Losing Weight and Lowering Risk: What you Need to Know about Women's Cancer and Nutrition -  Watch this free risk reduction webinar from Johns Hopkins.

Provider Education for Mental Health Care of Cancer Survivors (EMHCCS) Training - As many as three out of every four cancer survivors experiences symptoms of psychological distress or cognitive concerns, which can negatively affect their overall well-being and health outcomes. Distress screening is recommended for cancer patients in all clinical settings. The Centers for Disease Control and Prevention (CDC) offers free CME for this free, web-based webinar on mental health care of cancer survivors.

Bring Your Brave campaign - This joint effort from the USPSTF, ACS, and National Comprehensive Cancer Network includes resources for providers on current peer-reviewed evidence for screening, counseling, and testing.
show your support: Breast Cancer Awareness Month Activities in the Community

Visit the Delaware Breast Cancer Coalition events page or link directly to learn more about these and other community events.

New Castle County
Kent County
Sussex County
contact information

For more details about the Cancer Screening Quality Improvement Projects being led by Quality Insights , please contact Sarah Toborowski or Lisa Gruss.

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This publication was supported by the Cooperative Agreement Number NU58DP006349-02 from the Centers for Disease Control and Prevention. 
Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease 
Control and Prevention. Publication number DEDPH-CS -093019