Clinical Pearl of the Month – Breast Cancer Prevention

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Medical News

Clinical Pearl of the Month

Today’s Clinical Pearl of the Month question comes from the desk of Med-Challenger Family Medicine Editor, Gerard Kiernan, MD, FAAFP, FHM.

Test your skills with this review question.

Review Question

A 43-year-old white woman presents for health maintenance visit. She has history of menarche at age 12, first childbirth at age 28, and has a family history of breast cancer in her mother diagnosed at age 62. She does not have a history of blood clots. She has had two breast biopsies in the past, based on her history of self-identified lumps and fibrocystic breasts. Both biopsy results were benign. She is premenopausal.

She is a nonsmoker. After discussing breast cancer screening and risk, you enter her relevant details into the Gail model online calculator, yielding a five-year risk of invasive breast cancer of 3.7% and a lifetime risk of 27.9%. She and you elect to start regular mammographic screening.

Question

Which of the following additional steps would be most appropriate for this patient, based on history and breast cancer risk?

Answer Options:

Consider prescribing tamoxifen for the prevention of breast cancer.

Consider prescribing raloxifene for the prevention of breast cancer.

Refer patient for genetic counselling and testing for BRCA 1/2 gene mutations.

Consider referring patient for prophylactic mastectomy.

Answer Explanation & References:


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About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

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