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General lnternal Medicrne Breast Cancer Prevention and Screening Prevention The USPSTF recommends the following prevention for women aged >35 years with an increased risk for breast cancer (e.g., )3% risk in the next 5 years) and low risk for adverse medication effects: . tamoxifen before menopause . tamoxifen and raloxifene, or exemestane after menopause The USPSTF recommends that women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCAI/ 2) gene mutations be evaluated with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. Screening Screening recommendations vary. The USPSTF recommends biennial screening mammography for average-risk women begin- ning at age 50 years. Individualize screening decisions in women aged 75 or older based on breast cancer risk, overall prognosis and comorbid conditions, and personal patient preferences. Cervical Cancer Screening Screening The USPSTF recommends screening women aged 21 to 65 years every 3 years with cytologr (Pap test). In women aged 30 to 65 years who want to lengthen the screening interval, high-risk HPV testing (preferred) or cytologi combined with high risk HPV testing can be performed every 5 years (cotesting). The USPSTF recommends against routine screening in women younger than 21 years and in women older than 65 years (provided previous screenings yielded normal results, and the patient is not otherwise at high risk). The American Cancer Society recommends initiating screening at age 25 years with high-risk HPV testing alone (primary HPV testing) every 5 years until age 65 years. When primary HPV testing is unavailable, patients in this age range should preferably be screened with HPV cotesting (HPV testing with cervical cytolo$/) every 5 years or, alternatively, with cytologz alone every 3 years. Currently, two primary HPV tests and five HPV tests for cotesting are FDA approved. Screening can be discontinued at age 65 years in non-high-risk women with adequate previous screening:

The American Cancer Society recommends initiating screening at age 25 years with high-risk HPV testing alone (primary HPV testing) every 5 years until age 65 years. When primary HPV testing is unavailable, patients in this age range should preferably be screened with HPV cotesting (HPV testing with cervical cytolo$/) every 5 years or, alternatively, with cytologz alone every 3 years. Currently, two primary HPV tests and five HPV tests for cotesting are FDA approved. Screening can be discontinued at age 65 years in non-high-risk women with adequate previous screening: r three consecutive negative cltologr results, or . two consecutive negative cytologz plus HPV test results within the Iast 10 years, with the most recent test occurring within 5 years DON'T BE TRICKED o Do not screen women following a hysterectomy with cervix removal for benign disease (e.g., flbroids). o HPV vaccine does not protect against all HPV infections and does not treat existing HPV. . HPV vaccine can be given to patients who are HIV positive and otherwise immunosuppressed. 146