Guidelines for the Well-Woman Exam - CME Conferences
Guidelines for the Well-Woman Exam - CME Conferences Guidelines for the Well-Woman Exam - CME Conferences
2 nd Annual Primary Care Fall Conference Wednesday, October 24, 2012MammographyScreening Guidelines• ACOG, ACS, NCCN all concur Yearly beginning at age 40 vs. USPSTF points out• 1. Risks (e.g. false +’s leading toneedless biopsies and worry)• 2. lower prevalence – so lower PV+and greater NNS to prevent 1 death SBE is optional“I’m Worth It”41 y/o whose OB/GYNordered an initialmammogram at age 40A tiny lesion was seen.Needle-directed biopsy wasdone. Tumor Board metand recommended localexcision and radiation.David Plourd, MDWomen Exam
2 nd Annual Primary Care Fall Conference Wednesday, October 24, 2012MammographyScreening GuidelinesInsufficient Evidence• USPSTF (2009) [but based on old data1986-2006 ] INSUFFICIENT EVIDENCE FOR … After 75 y/o ( no mortality reduction ) Whether CBE adds value toscreening mammography The benefits / harms of digitalmammography or MRI instead ofconventional film mammographyUp to Date – Sep 2010• Strong evid for mammo 50—69 -stronger evid than for any otherCA (mammo’s at 40-50 definitely decreases Br CA mort –but is a rare condition – found at high cost)• Film (vs digital mammo) – optimalfor > 50 y/o Digital may offer advantage inyounger women with dense breasts Pisano 2005; Skaane 2007; Vinnicombe 2009• Q 2 yrs screening is 81% as goodas annual mammo. (Mandelblatt – 2003)David Plourd, MDWomen Exam
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2 nd Annual Primary Care Fall Conference Wednesday, October 24, 2012MammographyScreening <strong>Guidelines</strong>• ACOG, ACS, NCCN all concur Yearly beginning at age 40 vs. USPSTF points out• 1. Risks (e.g. false +’s leading toneedless biopsies and worry)• 2. lower prevalence – so lower PV+and greater NNS to prevent 1 death SBE is optional“I’m Worth It”41 y/o whose OB/GYNordered an initialmammogram at age 40A tiny lesion was seen.Needle-directed biopsy wasdone. Tumor Board metand recommended localexcision and radiation.David Plourd, MDWomen <strong>Exam</strong>
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