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Personalize Screening Guided Risk Level Average Moderate High Lifeme Risk <15% 15-40% >40% Dr. Holmes’ Age 20-39 Age 18-24 Age 18-24 Recommendaon .Monthly Self- .Monthly Breast Self- .Monthly Breast Self- Exam* Exam* Exam* .Doctor’s Exam at .Doctor’s Exam at least .Doctor’s exam yearly least every 3 years every 2 years Age 25-29 Age 40 & Older Age 25-34 .Monthly Breast Self- .Monthly Breast Self- .Monthly Breast Self- Exam* Exam* Exam* .Doctor’s exam twice .Doctor’s exam .Doctor’s exam once or yearly yearly twice each year .Mammograms Age 30 & Older yearly Age 35 & Older .Monthly Self-Exam* .Monthly Self-Exam* .Doctor’s exam twice .Doctor’s exam twice yearly yearly .Mammograms yearly .Mammograms yearly .MRI yearly .MRI yearly if risk ≥20%

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The Problem of the Dense

Breast Ultrasound (If a lump is felt but the mammogram looks normal, Always request an Ultrasound!!!)

Mass

Ultrasound

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Breast Magnetic Resonance Imaging (best for detecting cancer in dense breasts or in breasts with implants)

Breast MRI

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Indications for Annual Breast MRI From American Cancer Society

 BRCA 1 or BRCA 2 Mutaon  1st Degree Relave with BRCA 1 or 2 Mutaon  Lifeme Risk of >20%  Radiaon to chest between ages 10-30  Personal history of hereditary breast cancer (or 1st Degree Relave)  Li-Fraumeni syndrome, Cowden syndrome, or Bannayan- Riley-Ruvalcaba syndrome

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Making the Diagnosis

Making the Diagnosis

• Minimally Invasive Breast (MIBB) or needle biopsy is preferred at the inial step

• MIBB permits – Preoperave counseling regarding opons ( vs. ) – Planning of lymph node evaluaon – Planning of breast reconstrucon – Genec counseling if appropriate – Second opinions

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Making the Diagnosis  Obtain a Minimally Invasive Breast Biopsy Prior to Surgery  Ultrasound-guided core biopsy * PREFERRED  If ultrasound visible (palpable or not)  Stereotacc core biopsy * PREFERRED  If only microcalcificaons are present, if no visible by ultrasound, and is not palpable  Fine needle aspiraon or core biopsy  If palpable

 AVOID diagnosc excisional  However, a diagnosc excision biopsy might be necessary if minimally invasive biopsy is not possible Or if needle biopsy results are not believable

Ultrasound-Guided Core Biopsy (The preferred technique for biopsy of ultrasound visible masses)

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Stereotactic Core Biopsy

Dennis R. Holmes, M.D., F.A.C.S. www.drholmesmd.com www.lacwh.org Phone: 213-742-6400

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