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Recommendation for Surveillance Breast Imaging in Women with Personal History of Breast Cancer

Artifact Type
Multimodal
Creation Date
Version
1.0.0
Status
Draft
Experimental
False

Artifact Creation and Usage

Steward
Brigham and Woman's Hospital
Publisher
Brigham and Woman's Hospital
Contributors

Ronilda Lacson

Ramin Khorasani

Ali S. Raja

Louise Schneider

Michael Bakhtin

Mark Isabelle

Ivan Ip

License
Not Specified
IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.
No (Report infringement)
Copyrights

This CDS artifact and related data specifications are owned and stewarded by the Brigham and Women's Hospital (BWH). BWH is not responsible for any use of the CDS artifact. BWH makes no representations, warranties, or endorsement about the quality of any organization or physician that uses this CDS artifact.

Keywords
Breast cancer
Ductal carcinoma in situ
Mammogram
Breast MRI
Personal history of breast cancer
Patient preferences
Implementation Details
Miscellaneous Files
Flowchart_Wernli_new.pdf289.45 KB
Repository Information
Knowledge Level

Structured code that is interpretable by a computer (includes data elements, value sets, logic)

Purpose and Usage
Purpose

The purpose of this CDS is to ensure patient preferences are included in the decision process for choosing mammograms or breast MRIs in patients with a history of breast cancer.

Intended Population

Women with a personal history of breast cancer for whom either a mammogram or breast MRI is ordered for surveillance.

Usage

The tool is embedded in the Electronic Health Record, triggered by an order for a mammogram or breast MRI.

Cautions

 Physicians' counseling regarding increased biopsy and cancer detection rates may vary depending on patient scenarios.

Test Patients
sample_patients_wernli.zip4.22 KB
Supporting Evidence
Source Description

A published observational study demonstrated that the choice of mammograms vs. breast MRIs for surveillance should account for patient characteristics and preferences.

References

Wernli KJ, Ichikawa L, Kerlikowske K, Buist DSM, Brandzel SD, Bush M, et al. Surveillance Breast MRI and Mammography: Comparison in Women with a Personal History of Breast Cancer. Radiology. 2019;292(2):311-8.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694722/

Recommendation

Patient preferences should be considered in ordering breast imaging for breast cancer surveillance.

Strength of Recommendation

None

Quality of Evidence

Strength of Evidence

Based on Oxford Grade (2011): Level 3 (Screening) - Non-randomized controlled cohort/follow-up study

Source: Harvard Medical School Library of Evidence. Sign up for access: https://libraryofevidence.med.harvard.edu/app/library.

Harvard Medical School Library of Evidence website: https://libraryofevidence.hms.harvard.edu/

Oxford Centre for Evidence-Based Medicine Grading: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence

Artifact Representation
Triggers

Provider orders mammogram or breast MRI

Inclusions

Women with personal history of breast cancer, including ductal carcinoma in situ

Exclusions

Women with Stage 4 breast cancer

Interventions and Actions

Show a document containing information for selecting breast MRI or mammogram for surveillance, considering patient preferences.

Logic Files
Wernli Recommendations_1.txt524 bytes
CQL to CDS Hooks cards_3.txt153 bytes
wernli.zip9.81 KB
Use_of_CQL_12.txt431 bytes
Testing Experience