Review of Systems: Placement of Breast and Cervical Cancer History
A history of breast cancer belongs in the breast/chest section of the review of systems, while a history of cervical cancer belongs in the gynecologic section. These are organ-system specific histories that should be documented in their respective anatomical categories during a comprehensive review of systems.
Anatomical Organization of Cancer History
Breast Cancer History
- Document in the breast/chest section of the review of systems, as this represents a disease of breast tissue 1
- Include details about:
- Date of diagnosis and stage at presentation
- Type of breast cancer (ductal, lobular, etc.)
- Hormone receptor status (ER, PR, HER2)
- Treatment received (surgery type, chemotherapy, radiation, hormonal therapy)
- Current surveillance schedule and most recent imaging 1
Cervical Cancer History
- Document in the gynecologic section of the review of systems, as this represents a disease of the female reproductive tract 1
- Include details about:
- Date of diagnosis and stage
- HPV status if known
- Treatment received (surgery, radiation, chemotherapy)
- Whether hysterectomy was performed
- Current surveillance practices 1
Clinical Context and Family History Considerations
Importance of Family History Documentation
- Family history of breast and ovarian cancers in first-degree and second-degree relatives on both maternal and paternal sides should be regularly updated during preventive care encounters 1
- Approximately 8.4% of women report a family history of breast cancer in first-degree relatives 1
- Family history assessment is critical for identifying women who may need earlier or more intensive screening, including consideration for genetic testing 1
Common Documentation Pitfalls
- Studies reveal that fewer than half of women with a family history of breast cancer have their risk documented in the medical record 1
- Primary care providers often fail to take regular, thorough cancer family histories due to lack of knowledge and time/resources 1
- Update family history at every preventive care visit, not just initial encounters, as family history patterns can change over time 1
Integration with Screening Recommendations
- Women with a personal history of breast cancer require different surveillance than average-risk women and may need annual mammography plus MRI depending on their risk profile 1
- Women who have undergone hysterectomy for cervical cancer no longer require cervical cancer screening but need surveillance for recurrence 1
- The cancer-related checkup should include examination of relevant organ systems: thyroid, oral cavity, skin, lymph nodes, ovaries (women), and testicles (men) 2