Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington; Women's Health Care Center, Seattle, Washington.
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington; Seattle Veterans Affairs Medical Center, Seattle, Washington.
Mayo Clin Proc. 2020 Jun;95(6):1268-1275. doi: 10.1016/j.mayocp.2020.04.017.
Breast cancer-screening guidelines increasingly recommend that clinicians perform a risk assessment for breast cancer to inform shared decision making for screening. Precision medicine is quickly becoming the preferred approach to cancer screening, with the aim of increased surveillance in high-risk women, while sparing lower-risk women the burden of unnecessary imaging. Risk assessment also informs clinical care by refining screening recommendations for younger women, identifying women who should be referred to genetic counseling, and identifying candidates for risk-reducing medications. Several breast cancer risk-assessment models are currently available to help clinicians categorize a woman's risk for breast cancer. However, choosing the appropriate model for a given patient requires a working knowledge of the strengths, weaknesses, and performance characteristics of each. The aim of this article is to provide a stepwise approach for clinicians to assess an individual woman's risk for breast cancer and describe the features, appropriate use, and performance characteristics of commonly encountered risk-prediction models. This approach will help primary care providers engage in shared decision making by efficiently generating an accurate risk assessment and make clear, evidence-based screening and prevention recommendations that are appropriately matched to a woman's risk for breast cancer.
乳腺癌筛查指南越来越建议临床医生对乳腺癌进行风险评估，以告知筛查的共同决策。精准医学正迅速成为癌症筛查的首选方法，其目的是增加对高危女性的监测，同时使低危女性免受不必要的影像学检查的负担。风险评估还通过细化对年轻女性的筛查建议、确定应转介遗传咨询的女性以及确定有资格接受降低风险药物的候选者，为临床护理提供信息。目前有几种乳腺癌风险评估模型可帮助临床医生对女性的乳腺癌风险进行分类。然而，为特定患者选择合适的模型需要了解每个模型的优缺点和性能特征。本文的目的是为临床医生提供一种逐步评估女性个体乳腺癌风险的方法，并描述常见风险预测模型的特征、适当用途和性能特征。这种方法将帮助初级保健提供者通过有效地生成准确的风险评估来进行共同决策，并根据女性的乳腺癌风险做出明确、基于证据的筛查和预防建议。
