Breast Abscesses and Masses Guidelines

Updated: Apr 13, 2017
  • Author: Andrew C Miller, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Guidelines

Guidelines Summary

American College of Physicians (ACP) screening guidelines recommend the following: [50]

  • Mammography every 2 years from age 50-74 years
  • For women aged 40-49 years, guidelines advocate an individualized approach in which clinicians should base decisions on the potential benefits and harms of mammography, the woman's preferences, and her breast cancer risk profile
  • Current evidence recommends against breast cancer screening with mammography in women younger than 40 years, women older than 75 years, and women with a serious medical condition who have a life expectancy of less than 10 years. However, physicians and patients should discuss the risks and benefits of mammography based on the patient’s wishes and other associated breast cancer risks.

American Cancer Society (ACS) screening guidelines recommend the following: [51]

  • For women aged 40-44 years, the choice to begin annual breast cancer screening with mammography should be based on the potential risks/benefits and patient’s wishes.
  • For women aged 45-54 years, mammography should be completed annually.
  • For women aged 55 years and older, mammography should be completed every 2 years and continued until life expectancy falls below 10 years.

The US Preventive Services Task Force (USPSTF) screening guidelines recommend the following: [52]

  • Mammography every 2 years between age 50 and 74 years
  • For women aged 40-49 years, guidelines advocate an individualized approach in which clinicians should base decisions on the potential benefits and harms of mammography, the woman's preferences, and her breast cancer risk profile
  • The USPSTF has found insufficient evidence to make a recommendation about breast cancer screening in women younger than 40 years or older than 75 years.

The above guidelines share the following recommendations:

  • No clear recommendations for breast self-examination
  • No clear recommendation for clinical breast examination

ACP and ACS guidelines do not recommend the use of MRI or digital breast tomosynthesis for the purposes of breast cancer screening. USPSTF has found insufficient evidence to provide a recommendation about either of these breast cancer screening modalities.

French College of Gynecologists and Obstetricians (CNGOF) screening guidelines recommend the following: [53]

  • Screening with breast ultrasonography in combination with mammography is needed to investigate a clinical breast mass (grade B), colored single-pore breast nipple discharge (grade C), or mastitis (grade C).
  • The BI-RADS system is recommended for describing and classifying abnormal breast imaging findings.
  • For a breast abscess, a percutaneous biopsy is recommended in the case of a mass or persistent symptoms (grade C).
  • For mastalgia, when breast imaging findings are normal, no MRI or breast biopsy is recommended (grade C). Percutaneous biopsy is recommended for a BI-RADS category 4-5 mass (grade B).
  • For persistent erythematous nipple or atypical eczema lesions, a nipple biopsy is recommended (grade C).
  • For distortion and asymmetry, a vacuum core-needle biopsy is recommended owing to the risk of underestimation by simple core-needle biopsy (grade C).
  • For BI-RADS category 4-5 microcalcifications without any ultrasound signal, a minimum 11-G vacuum core-needle biopsy is recommended (grade B). In the absence of microcalcifications on radiography cores, additional samples are recommended (grade B).
  • For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia, radial scar and mucocele with atypia, surgical excision is commonly recommended (grade C). Expectant management is feasible after multidisciplinary consensus. For these lesions, when excision margins are not clear, no new excision is recommended except for LCIS characterized as pleomorphic or with necrosis (grade C).
  • For grade 1 phyllodes tumor, surgical resection with clear margins is recommended.
  • For grade 2 phyllodes tumor, 10-mm margins are recommended (grade C).
  • For papillary breast lesions without atypia, complete disappearance of the radiological signal is recommended (grade C).
  • For papillary breast lesions with atypia, complete surgical excision is recommended (grade C).