Patient handout

Preventive breast-cancer screening (adult)

PRODUCTION

1. Your condition

This handout is for preventive breast-cancer screening (adult). Your care team identified this based on: routine preventive/wellness visit — breast screening due (uspstf 2024 biennial 40-74 grade b pmid 38687503).

Other reasons your team may use this plan: known hereditary risk (brca1/2, li-fraumeni tp53, prior chest rt age 10-30) requiring intensified mri surveillance (acs 2015 pmid 26501536; nccn); overdue or never-screened woman/afab identified at any encounter (uspstf 2024); follow-up after a positive screening mammogram — apply bi-rads ppv reasoning, route to diagnostic workup (uspstf 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
screening_mammography_biennial_40_74	Biennial digital mammography, age 40-74	imaging	q2yr	USPSTF 2024 (Nicholson JAMA 2024 PMID 38687503) Grade B biennial 40-74 — moderate net benefit; CISNET (Trentham-Dietz JAMA 2024 PMID 38687505): biennial DBT 40-74 = 30.0% breast-ca mortality reduction, 8.2 deaths averted/1000, 1376 false-positive recalls + 14 overdiagnosed/1000. UK Age RCT (Duffy HTA 2020 PMID 33141657): intervention-phase mortality RR 0.75 (25%↓, 95% CI 0.58-0.97) at 10 yr, ~1 death/1000.
digital_breast_tomosynthesis_dbt	Biennial DBT/tomosynthesis age 40-74 (preferred where available)	imaging	q2yr	DBT: similar mortality benefit to digital mammography with FEWER false-positive recalls; Svahn meta-analysis (Breast 2015 PMID 26433751) FP:TP ratio 2D→2D/3D improved 30-55% (STORM 5.96→3.17; Oslo 10.25→7.07). CISNET PMID 38687505 used DBT as the modeled modality.
supplemental_breast_mri_high_risk	Annual MRI + mammography from age 25-30 (or 10 yr before youngest FDR dx)	imaging	annual	ACS 2015 (Oeffinger JAMA 2015 PMID 26501536) / NCCN — lifetime ≥20% (Tyrer-Cuzick) or BRCA/TP53/mantle-RT prior is high enough that MRI sensitivity gain net-benefits. DENSE RCT (Bakker NEJM 2019 PMID 31774954): supplemental MRI in extremely dense breasts cut interval cancers 5.0→2.5/1000 (Δ2.5, 95% CI 1.0-3.7).
tamoxifen	20 mg	PO	daily × 5 yr	USPSTF 2019 risk-reducing therapy when Gail/BCRAT 5-yr ≥1.67%; Cuzick SERM meta-analysis (Lancet 2013 PMID 23639488) breast-ca incidence HR 0.62 (38%↓), NNT 42/10 yr, VTE OR 1.73. RxCUI 10324 RxNav-verified 2026-05-16 — NEEDS_RXNAV_VALIDATION.
raloxifene	60 mg	PO	daily × 5 yr	USPSTF 2019; included in Cuzick SERM meta-analysis (PMID 23639488 HR 0.62) — postmenopausal, lower VTE/endometrial risk than tamoxifen. RxCUI 72143 RxNav-verified by name lookup 2026-05-16 (parent dossier 72567 was STALE) — NEEDS_RXNAV_VALIDATION.
exemestane	25 mg	PO	daily × 5 yr	MAP.3 RCT (Goss NEJM 2011 PMID 21639806): invasive breast-ca 0.19% vs 0.55%, HR 0.35 (65%↓, 95% CI 0.18-0.70); musculoskeletal/bone harm; second-line postmenopausal chemoprevention (USPSTF 2019). RxCUI 258494 RxNav-verified by name lookup 2026-05-16 — NEEDS_RXNAV_VALIDATION.
anastrozole	1 mg	PO	daily × 5 yr	Aromatase-inhibitor chemoprevention alternative (IBIS-II analogue) postmenopausal high-risk; class effect mirrors MAP.3 exemestane (Goss PMID 21639806). RxCUI 84857 RxNav-verified 2026-05-16 (tty IN) — NEEDS_RXNAV_VALIDATION.

Plan: Breast — mammography/DBT ± supplemental MRI + chemoprevention (USPSTF 2024 Grade B biennial 40-74 PMID 38687503; CISNET PMID 38687505; USPSTF 2019)

3. When to call your provider

Contact your care team if any of the following happen:

BI-RADS 4-5 → breast surgery/biopsy (ACR BI-RADS; USPSTF 2024 PMID 38687503)
Biopsy-proven malignancy → breast oncology / multidisciplinary tumor board
Hereditary syndrome confirmed → NCCN high-risk protocol + cascade testing (NCCN)
Palpable mass / bloody nipple discharge / skin change → diagnostic breast imaging, NOT screening interval

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

BI-RADS 4 (PPV ~2-95%) or 5 (PPV ≥95%) — post-test probability now high enough that the harm of NOT biopsying exceeds the harm of the diagnostic core-biopsy cascade
Confirmed BRCA1/2 (lifetime breast risk ~55-72%), Li-Fraumeni TP53, or prior chest radiation age 10-30 — very high prior requiring earlier (age 25-30) + more frequent (annual MRI + mammography) surveillance
Palpable breast mass, bloody/spontaneous nipple discharge, skin retraction/peau d'orange, or focal persistent pain — a fundamentally different (much higher) prior than asymptomatic screening

5. Follow-up

STOP-screening / deprescribing-equivalent: discontinue when life expectancy <10 yr OR age >74 (USPSTF 2024 I-statement — evidence insufficient ≥75; ACS 2015 continue while ≥10-yr life expectancy PMID 26501536). Genetic-counseling referral if criteria met. Chemoprevention follow-up. Patient education on the false-positive recall cascade (CISNET 1376/1000 biennial DBT 40-74) and overdiagnosis (~14/1000) — the harm side of the Bayesian ledger (USPSTF 2024 PMID 38687503; CISNET PMID 38687505)

6. Sources

Guideline: USPSTF 2024 breast-cancer screening recommendation statement (biennial mammography 40-74 Grade B; ≥75 I-statement; dense-breast supplemental I-statement) + CISNET collaborative modeling decision analysis; ACS 2015 breast guideline; USPSTF 2019 risk-reducing medications