Breast Screening and Evaluation, High Risk Patients

The fundamental tasks facing surgeons evaluating patients’ breasts are to rule out malignancy, ameliorate breast symptoms, and manage premalignant breast conditions and risk factors to minimize a patient’s chances of developing cancer. Woman presenting to a surgeon should receive thorough and appropriate breast evaluation, breast cancer risk assessment, and treatment, which minimizes risks going forward. In this review, we focus on screening recommendations for (both average and high-risk) patients for breast cancer, Breast Imaging, Reporting and Data System categories, the performance of a thorough breast history and physical examination. We also discuss various breasts imaging modalities and their strengths and weaknesses. We review breast density as a confounding factor and increased risk factor, and the grading of breast density. Finally, different ways of performing breast biopsies are discussed as well as the evaluation of risk for breast cancer with interventions for enhanced screening and risk reduction. This review contains 12 figures, 7 tables, and 35 references.  Key Words: BI-RADs, breast cancer risk factors, breast cancer risk reduction, breast core biopsy, breast screening, enhanced screening, BRCA, chemoprevention, mammography