CLINICAL DECISION MAKING - Screening for
Reading for Session 2 (S. Fisher): Screening for Breast
Outline of the Formal Clinical Decision Making Process
Breast cancer represents an enormous challenge to the health system. In this
session, we focus on the items in the following outline:
- Accuracy - breast self exam; clinical breast exam; mammography
- Cost/burden of misclassification - physician visits, surgical procedures,
radiation exposure, psychological impact.
- Early detection - benefit, impact of research on screening recommendations,
future trends in breast cancer incidence and mortality.
- Community-based screening programs - availability, focus, cost effectiveness, and
impact See attached reading material on the Epidemiology of Breast Cancer.
- Tumor Biology
- Genetic factors related to susceptibility - BRCA1, BRCA2, Li-Fraumeni syndrome
- Genetic alterations affecting neoplastic phenotype - growth factor receptors
(HER2/neu), cell cycle regulators, regulators of apoptosis
- Genetic changes associated with tumor progression - aneuploidy, drug resistance,
- Genetic testing - assessments and counseling, ethical implications (insurance,
- Future clinical decision - theoretical health care policy presentations by
faculty - Mandatory genetic testing, use of molecular markers for breast cancer screening,
good markers/bad markers in a managed care environment.