Breast Cancer

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1/8 Women will develop breast cancer.

Breast Cancer: Biennial screening

50-74 years: mammography

over 75 years: Insufficient evidence to recommend mammography.

If you want to discuss mammography orders, please visit our clinic.

But the general guidelines are:

Essential elements of management for breast cancer survivors who have completed active treatment and have no evidence of disease are cancer surveillance, encouragement of adherence with ongoing treatment and lifestyle recommendations, treatment of medical and psychosocial consequences of cancer and its therapy, and care coordination between specialists and primary care providers.

Survivor follow-up should include updated history, regular physical examination, and breast imaging (ie, mammography). The follow-up should not only focus on cancer surveillance, but also on any late-treatment related complications, psychosocial issues, and occupational problems.

All women with breast cancer should be counseled about the role of genetic testing and counseling.

Laboratory studies or radiologic imaging to screen for distant recurrence in asymptomatic patients should not be performed.

All breast cancer survivors should pursue a healthy lifestyle that includes following a prudent diet, pursuing or maintaining an active exercise program, minimizing alcohol intake, and refraining from smoking.

Treatment may affect many aspects of sexuality, and breast cancer survivors should be routinely questioned about concerns related to sexual health and counseled or referred as needed.

Although data are limited, studies do not indicate increased risk of recurrence for survivors who become pregnant or an impact on pregnancy outcomes.

For women with breast cancer who wish to preserve fertility but delay pregnancy, we suggest not administering hormonal contraception . Physicians should counsel women about methods most consistent with their lifestyle and beliefs. Alternative forms of contraception include copper IUD and barrier methods.

A variety of clinicians may adequately follow women after their primary therapy for breast cancer. Clinicians should be experienced in the surveillance of these patients, the complications that may arise from treatment, and in breast examination, including the examination of irradiated breasts. A shared care model that integrates both specialists and primary care providers on ongoing follow-up care may provide the best adherence to guidelines for recommended care; but communication and coordination of care is required.

Pneumococcal Vaccine

Single Dose at age > 65 years of age.

PCV13 Vaccine

Pneumococcal conjugate vaccine (called PCV13) protects against 13 types of pneumococcal bacteria.

PCV13 is routinely given to children at 2, 4, 6, and 12–15 months of age. It is also recommended for children and adults 2 to 64 years of age with certain health conditions, and for all adults 65 years of age and older. Your doctor can give you details.

Some people should not get this vaccine

Anyone who has ever had a life-threatening allergic reaction to a dose of this vaccine, to an earlier pneumococcal vaccine called PCV7, or to any vaccine containing diphtheria toxoid (for example, DTaP), should not get PCV13.

Anyone with a severe allergy to any component of PCV13 should not get the vaccine. Tell your doctor if the person being vaccinated has any severe allergies.

If the person scheduled for vaccination is not feeling well, your healthcare provider might decide to reschedule the shot on another day.

Health Promotion

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Life style modification: Obesity, Smoking, Alcoholism

Number ONE cause of preventable morbidity in the United States is: TOBACCO. Stop consuming tobacco.


Primary: Immunizations

Secondary: Screening

Tertiary: How to help patient when the disease is already here.

Quaternary: Don’t do unnecessary things; Pap tests after the age of 65; Hemoccult after normal colonoscopy. Join ‘Choosing Wisely Campaign’.

-A Great App to see Preventive Health Services. Please go to the following site to download US Preventive Health Services recommendations.

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Obesity: BMI over 25, is overweight.

BMI over 30 is Obese.

Watch Weight of the Nation Documentary.

*Physical Activity Guidelines: 

Work on muscle groups two or more days of a week.

Moderate Aerobic Activity: 150 minutes/week (Brisk Walking)

Vigorous Aerobic Activity: 75 minutes/week (Jogging or Running)


Acceptable, Men less than or equal to 2 drinks per day; Women less than or equal to 1 drink per day.

-Primary Prevention:

Example: Immunizations.

You can save 50,000 adult lives per year using vaccines.

In children, 730,000 deaths could be prevented.

=Breastfeeding is NOT a contradiction to vaccines. (Check this website for vaccine recommendations)

=Children with a history of sexual assault should be vaccinated against HPV starting at 9 years of age.

=Tdap is safe during pregnancy.

=Don’t use these vaccines in pregnancy: MMR, Varicella, HPV, Influenza LAV