Standing Order for Breast Cancer Screening

Standing Order Number: SO221

Departments: Clinical Operations, Medical Providers

Date of last update: 10/17/2024

Approved by: Tom Stephens, MD

Approval/effective date: 10/18/2024

Approval signature:

Purpose

To provide a process for non-provider staff to order screening mammograms for eligible patients to improve screening rates and decrease morbidity and mortality related to breast cancer.

Eligible Staff

Eligible staff listed below are authorized to act as agents delegated to order screening mammograms:

• RNs

Eligible Patients

All women and other patients assigned female at birth* who are:

• aged 40-74

• have not had a screening mammogram in the last 1-2 years, and

• have been seen as a patient within the past 3 years

*(including transgender men and nonbinary individuals)

Exclusions

• Bilateral total mastectomy

• Breast symptoms such as pain, palpable lump, or nipple discharge.

  • Discuss ordering a diagnostic mammogram with an appropriate provider.

Procedure

At any opportunity, eligible staff will:

• Place order on behalf of the usual provider, determined through review of the medical record, using a standardized EMR short list.

  • Order must include the diagnosis code, test CPT code, and information on imaging facilities.  Output order as requested.

  • For women with a history of unilateral mastectomy, order a unilateral screening mammogram and indicate the side to be screened.

• If a previous mammogram has been completed, encourage the patient to return to the same facility.  If the patient prefers to change, encourage the patient to have previous images sent to the new facility for comparison.

• If patient needs assistance with scheduling, assist or send a message to “cancer navigation pool” for help.

• Review mammogram prep with patient, including no powder, lotions, or deodorants.

Follow-up and Communication

• Communicate any pertinent clinical information provided by the patient to the patient’s clinician. If the patient reports related symptoms not yet evaluated, discuss with patient’s clinician before placing an order.

• If the patient is due for cervical cancer screening, encourage scheduling a Well Woman Exam.  If no office visit in the previous 12 months or the plan indicates that follow up is due, schedule a follow up appointment.

Reference

• USPSTF Final Recommendation Statement on Screening for Breast Cancer, 4/30/2024 https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

Westside’s breast cancer screening protocols are based on USPSTF guidelines but provide some flexibility for patient preference to follow other recognized guidelines such as those from the American Cancer Society, American College of Radiology, etc.